Provider Demographics
NPI:1154588663
Name:KOTHA, PREETI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PREETI
Middle Name:
Last Name:KOTHA
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 1:795 E 2ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2007
Mailing Address - Country:US
Mailing Address - Phone:909-706-3765
Mailing Address - Fax:909-706-3731
Practice Address - Street 1:795 E 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3765
Practice Address - Fax:909-706-3731
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist