Provider Demographics
NPI:1184876633
Name:KADIYALA, CHANDRA SEKHAR RAO (BPHARM, MTECH, PHD)
Entity type:Individual
Prefix:DR
First Name:CHANDRA SEKHAR RAO
Middle Name:
Last Name:KADIYALA
Suffix:
Gender:M
Credentials:BPHARM, MTECH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 S COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2837
Mailing Address - Country:US
Mailing Address - Phone:209-929-1093
Mailing Address - Fax:209-929-1096
Practice Address - Street 1:123 S COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2837
Practice Address - Country:US
Practice Address - Phone:209-929-1093
Practice Address - Fax:209-929-1096
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00069476183500000X
CA68509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist