Provider Demographics
NPI:1730456534
Name:GHANTA, USHARANI
Entity Type:Individual
Prefix:
First Name:USHARANI
Middle Name:
Last Name:GHANTA
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 1:1306 S MARY AVE # 66
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3130
Mailing Address - Country:US
Mailing Address - Phone:408-732-2729
Mailing Address - Fax:408-732-3085
Practice Address - Street 1:1306 S MARY AVE # 66
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3130
Practice Address - Country:US
Practice Address - Phone:408-732-2729
Practice Address - Fax:408-732-3085
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH62809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist