Healthcare Provider Details

I. General information

NPI: 1750639035
Provider Name (Legal Business Name): PRAMUKH HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 BLOSSOM HILL RD STE 101
SAN JOSE CA
95123-1653
US

IV. Provider business mailing address

PO BOX 1047
RICHMOND TX
77406-0027
US

V. Phone/Fax

Practice location:
  • Phone: 408-224-8192
  • Fax: 408-224-8173
Mailing address:
  • Phone: 281-232-3940
  • Fax: 832-595-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number52488
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SANDRA SCOTT
Title or Position: DELEGATED OFFICIAL,AO
Credential:
Phone: 832-646-5119