Provider Demographics
NPI:1710084256
Name:BHAVARAJU, SYAMALA THOTA (MPHARM)
Entity Type:Individual
Prefix:MRS
First Name:SYAMALA
Middle Name:THOTA
Last Name:BHAVARAJU
Suffix:
Gender:F
Credentials:MPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 VIA MARISOL
Mailing Address - Street 2:APT#120
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-5084
Mailing Address - Country:US
Mailing Address - Phone:213-253-2677
Mailing Address - Fax:213-253-5019
Practice Address - Street 1:351 E TEMPLE ST # 119
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3328
Practice Address - Country:US
Practice Address - Phone:213-253-2677
Practice Address - Fax:213-253-5019
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030347-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist