Provider Demographics
NPI:1053697102
Name:RAO, PROTIMA (RPH)
Entity type:Individual
Prefix:MRS
First Name:PROTIMA
Middle Name:
Last Name:RAO
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 1:2300 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2854
Mailing Address - Country:US
Mailing Address - Phone:650-568-4049
Mailing Address - Fax:650-568-4046
Practice Address - Street 1:2300 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2854
Practice Address - Country:US
Practice Address - Phone:650-568-4049
Practice Address - Fax:650-568-4046
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist