Provider Demographics
NPI:1902998859
Name:KUMAR, SUNDARAM PRAVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:SUNDARAM
Middle Name:PRAVIN
Last Name:KUMAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2682 CRYER ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-3022
Mailing Address - Country:US
Mailing Address - Phone:510-785-4588
Mailing Address - Fax:
Practice Address - Street 1:795 WILLOW ROAD
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-617-2773
Practice Address - Fax:650-617-2696
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist