Healthcare Provider Details

I. General information

NPI: 1801268487
Provider Name (Legal Business Name): VASANTHA ESWARA R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 PARK DR
EL DORADO HILLS CA
95762-4579
US

IV. Provider business mailing address

1776 TOBY DR
EL DORADO HILLS CA
95762-7662
US

V. Phone/Fax

Practice location:
  • Phone: 916-933-0374
  • Fax:
Mailing address:
  • Phone: 916-941-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: