Provider Demographics
NPI:1699910166
Name:KRISHNARAJAN, JOHN (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KRISHNARAJAN
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 FOPPIANO WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-6899
Mailing Address - Country:US
Mailing Address - Phone:707-836-0436
Mailing Address - Fax:
Practice Address - Street 1:3550 ROUND BARN BLVD
Practice Address - Street 2:SUITE # 109
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1796
Practice Address - Country:US
Practice Address - Phone:707-566-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist