Provider Demographics
NPI:1710588397
Name:KOTHARU, NARAYANA PRASAD (RPH)
Entity Type:Individual
Prefix:
First Name:NARAYANA PRASAD
Middle Name:
Last Name:KOTHARU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:PRASAD
Other - Middle Name:
Other - Last Name:KOTHARU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1215 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-5099
Mailing Address - Country:US
Mailing Address - Phone:214-797-1010
Mailing Address - Fax:
Practice Address - Street 1:1635 MARKET PL
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7239
Practice Address - Country:US
Practice Address - Phone:214-574-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist