Provider Demographics
NPI:1386912442
Name:GOMATAM, RADHA MURALI (RPH)
Entity type:Individual
Prefix:
First Name:RADHA
Middle Name:MURALI
Last Name:GOMATAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 S MARY AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3130
Mailing Address - Country:US
Mailing Address - Phone:408-732-2729
Mailing Address - Fax:408-732-3085
Practice Address - Street 1:1306 S MARY AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3130
Practice Address - Country:US
Practice Address - Phone:408-732-2729
Practice Address - Fax:408-732-3085
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH43339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist