Provider Demographics
NPI:1205141348
Name:RUDRAPRAKASHA, BANGALORE S
Entity type:Individual
Prefix:MR
First Name:BANGALORE
Middle Name:S
Last Name:RUDRAPRAKASHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E HARVARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3315
Mailing Address - Country:US
Mailing Address - Phone:805-525-4014
Mailing Address - Fax:805-525-5864
Practice Address - Street 1:221 E HARVARD BLVD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3315
Practice Address - Country:US
Practice Address - Phone:805-525-4014
Practice Address - Fax:805-525-5864
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 63086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist