Provider Demographics
NPI:1750639035
Name:PRAMUKH HEALTHCARE LLC
Entity Type:Organization
Organization Name:PRAMUKH HEALTHCARE LLC
Other - Org Name:BLOSSOM HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED OFFICIAL,AO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-646-5119
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-0027
Mailing Address - Country:US
Mailing Address - Phone:281-232-3940
Mailing Address - Fax:832-595-1203
Practice Address - Street 1:393 BLOSSOM HILL RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1653
Practice Address - Country:US
Practice Address - Phone:408-224-8192
Practice Address - Fax:408-224-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336L0003X
CA524883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2151607OtherPK