=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811343304
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAILAJA KARANTI PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2016
-----------------------------------------------------
Last Update Date | 05/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 72780 COUNTRY CLUB DR STE # 403
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-610-6512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 VIA SANTO TOMAS
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-5816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-625-4447
-----------------------------------------------------
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 | 66292
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------