Provider Demographics
NPI:1790070498
Name:NARRA, CHARUMATHY VIVEK
Entity Type:Individual
Prefix:
First Name:CHARUMATHY
Middle Name:VIVEK
Last Name:NARRA
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 1:2425 CLARIBEL RD
Mailing Address - Street 2:T2096
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9456
Mailing Address - Country:US
Mailing Address - Phone:209-863-1277
Mailing Address - Fax:209-863-1277
Practice Address - Street 1:2425 CLARIBEL RD
Practice Address - Street 2:T2096
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-9456
Practice Address - Country:US
Practice Address - Phone:209-863-1277
Practice Address - Fax:209-863-1277
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist