Provider Demographics
NPI:1821438904
Name:PRABHU, LATHA DINESH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LATHA
Middle Name:DINESH
Last Name:PRABHU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34768 TUXEDO CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2746
Mailing Address - Country:US
Mailing Address - Phone:510-797-3247
Mailing Address - Fax:
Practice Address - Street 1:34768 TUXEDO CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2746
Practice Address - Country:US
Practice Address - Phone:510-797-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 61603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist