Provider Demographics
NPI:1952538845
Name:RAMBHATLA, PAVANKUMAR (RPH, CIP)
Entity type:Individual
Prefix:
First Name:PAVANKUMAR
Middle Name:
Last Name:RAMBHATLA
Suffix:
Gender:M
Credentials:RPH, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S FRONT ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2099
Mailing Address - Country:US
Mailing Address - Phone:717-782-3200
Mailing Address - Fax:717-782-5507
Practice Address - Street 1:111 S FRONT ST STE 1
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-3200
Practice Address - Fax:717-782-5507
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist