Healthcare Provider Details

I. General information

NPI: 1497905525
Provider Name (Legal Business Name): MRS. PADMA M KOSARAJU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27322 CARRONADE DR
PERRYSBURG OH
43551-3368
US

IV. Provider business mailing address

25204 ROCKY HARBOUR DR
PERRYSBURG OH
43551-7620
US

V. Phone/Fax

Practice location:
  • Phone: 567-336-4659
  • Fax:
Mailing address:
  • Phone: 419-378-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03127699
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: