Healthcare Provider Details

I. General information

NPI: 1508465535
Provider Name (Legal Business Name): UDAY BHASKAR NARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3172 NEW MATHIS RD STE 1
ELMENDORF TX
78112-7811
US

IV. Provider business mailing address

2073 CULLUM PARK
SAN ANTONIO TX
78253-4435
US

V. Phone/Fax

Practice location:
  • Phone: 210-794-0099
  • Fax: 210-908-9994
Mailing address:
  • Phone: 601-913-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: