Provider Demographics
NPI:1750593505
Name:VELAYUDHAN, PALANGAT ODAYOTH (RPH)
Entity type:Individual
Prefix:MR
First Name:PALANGAT
Middle Name:ODAYOTH
Last Name:VELAYUDHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81503-1393
Mailing Address - Country:US
Mailing Address - Phone:970-242-8954
Mailing Address - Fax:970-242-7420
Practice Address - Street 1:400 N 1ST ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2230
Practice Address - Country:US
Practice Address - Phone:970-263-7415
Practice Address - Fax:970-242-7420
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist