Healthcare Provider Details

I. General information

NPI: 1053835595
Provider Name (Legal Business Name): STANFORD HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BLAKE WILBUR DR STE CC1102
PALO ALTO CA
94304-2205
US

IV. Provider business mailing address

875 BLAKE WILBUR DR STE CC1102
PALO ALTO CA
94304-2205
US

V. Phone/Fax

Practice location:
  • Phone: 650-736-3800
  • Fax: 650-736-7991
Mailing address:
  • Phone: 650-736-3800
  • Fax: 650-736-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55482
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HARI CHANDANA MULAMALLA
Title or Position: EXECUTIVE DIRECTOR,PHARMACY SERVICE
Credential: PHARMD
Phone: 312-215-0088