=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669710604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIDHU OHRI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2013
-----------------------------------------------------
Last Update Date | 02/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4380 SAN JUAN AVE
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-230-6145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35640 FREMONT BLVD # 420
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94536-3420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-585-3657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 59322
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------