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Individual
RAJA S GORANTLA
Active
Individual
RAJA S GORANTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
049428
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02498704
—
NY
01
—
026389
NY BOARD OF PHARMACY
NY
01
—
1720185663
PHARMACY NPI
NY
01
—
3376440
NABP
—
Enumeration date
01/02/2009
Last updated
01/09/2009
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