MEDICARE: AMBILY GOPINATHAN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	67734	TX

General Provider Information

NPI Number	:	1699492355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBILY GOPINATHAN RPH

Provider Business Mailing Address
First Line	:	1710 N RICHMOND RD
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-2713
Country	:	US
Telephone Number	:	979-532-8660
Fax Number	:	979-532-8496

Provider Business Practice Location Address
First Line	:	1710 N RICHMOND RD
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-2713
Country	:	US
Telephone Number	:	979-532-8660
Fax Number	:	979-532-8496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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Directions to “ AMBILY GOPINATHAN RPH” Practice Location

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