Provider Demographics
NPI:1710464839
Name:RAMAMOORTHY, SUBATHRA
Entity Type:Individual
Prefix:
First Name:SUBATHRA
Middle Name:
Last Name:RAMAMOORTHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 RELER LN APT L
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3804
Mailing Address - Country:US
Mailing Address - Phone:615-668-6817
Mailing Address - Fax:
Practice Address - Street 1:10 RELER LN APT L
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3804
Practice Address - Country:US
Practice Address - Phone:615-668-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03920900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03920900OtherPHARMACIST LICENCE