Provider Demographics
NPI:1699492355
Name:GOPINATHAN, AMBILY (RPH)
Entity type:Individual
Prefix:
First Name:AMBILY
Middle Name:
Last Name:GOPINATHAN
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 1:1710 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2713
Mailing Address - Country:US
Mailing Address - Phone:979-532-8660
Mailing Address - Fax:979-532-8496
Practice Address - Street 1:1710 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2713
Practice Address - Country:US
Practice Address - Phone:979-532-8660
Practice Address - Fax:979-532-8496
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist