Healthcare Provider Details

I. General information

NPI: 1093726689
Provider Name (Legal Business Name): PRAMUKH MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 S CATALINA AVE
REDONDO BEACH CA
90277-5504
US

IV. Provider business mailing address

1708 S CATALINA AVE
REDONDO BEACH CA
90277-5504
US

V. Phone/Fax

Practice location:
  • Phone: 310-540-4441
  • Fax: 310-540-5274
Mailing address:
  • Phone: 310-540-4441
  • Fax: 310-540-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY48668
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RAKESH PATEL
Title or Position: PARTNER
Credential:
Phone: 310-540-4441