Provider Demographics
NPI:1265904601
Name:BHARADHWAJ, AADITHYAA BALAJI (PHARMD)
Entity type:Individual
Prefix:
First Name:AADITHYAA
Middle Name:BALAJI
Last Name:BHARADHWAJ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 BROOKTREE LN APT 264
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8683
Mailing Address - Country:US
Mailing Address - Phone:760-331-8609
Mailing Address - Fax:
Practice Address - Street 1:3752 MISSION AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1417
Practice Address - Country:US
Practice Address - Phone:760-722-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH79178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist