=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518567619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARUN KRISHNA KROTHAPALLI RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2020
-----------------------------------------------------
Last Update Date | 10/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S DR EE DUNLAP ST STE C
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78384-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-209-8322
-----------------------------------------------------
Fax | 361-209-5022
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 S DR EE DUNLAP ST STE C
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78384-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-209-8322
-----------------------------------------------------
Fax | 361-209-5022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 64088
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------