Provider Demographics
NPI:1750870978
Name:ALEX, SHRUTHY (RPH)
Entity type:Individual
Prefix:
First Name:SHRUTHY
Middle Name:
Last Name:ALEX
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 1:600 S ABEL ST UNIT 425
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-8696
Mailing Address - Country:US
Mailing Address - Phone:408-913-5115
Mailing Address - Fax:
Practice Address - Street 1:600 S ABEL ST UNIT 425
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-8696
Practice Address - Country:US
Practice Address - Phone:408-913-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77746OtherPHARMACY