Healthcare Provider Details

I. General information

NPI: 1710588397
Provider Name (Legal Business Name): NARAYANA PRASAD KOTHARU RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PRASAD KOTHARU RPH

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 MARKET PL
IRVING TX
75063-7239
US

IV. Provider business mailing address

1215 VALLEY VISTA DR
IRVING TX
75063-5099
US

V. Phone/Fax

Practice location:
  • Phone: 214-574-4522
  • Fax:
Mailing address:
  • Phone: 214-797-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number44944
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: