Provider Demographics
NPI:1336511419
Name:GADDE, PADMAJA (RPH)
Entity Type:Individual
Prefix:
First Name:PADMAJA
Middle Name:
Last Name:GADDE
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 1:15899 CONCORD RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-4162
Mailing Address - Country:US
Mailing Address - Phone:858-472-5591
Mailing Address - Fax:
Practice Address - Street 1:10560 4S COMMONS DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-3511
Practice Address - Country:US
Practice Address - Phone:858-673-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist