Provider Demographics
NPI:1740571371
Name:VENUGOPAL, RAJASEKAREN (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAJASEKAREN
Middle Name:
Last Name:VENUGOPAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-2331
Mailing Address - Country:US
Mailing Address - Phone:559-389-8393
Mailing Address - Fax:559-788-2567
Practice Address - Street 1:66 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2331
Practice Address - Country:US
Practice Address - Phone:559-389-8393
Practice Address - Fax:559-788-2567
Is Sole Proprietor?:No
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist