Provider Demographics
NPI:1124645304
Name:RAO, SANJANA (PHARMD)
Entity type:Individual
Prefix:
First Name:SANJANA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 TERRACE WAY
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1564
Mailing Address - Country:US
Mailing Address - Phone:267-575-4030
Mailing Address - Fax:
Practice Address - Street 1:800 W HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-3929
Practice Address - Country:US
Practice Address - Phone:707-443-8311
Practice Address - Fax:707-443-2784
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist