Provider Demographics
NPI:1528274917
Name:RAMAIYAN, ELANGO S (RPH)
Entity type:Individual
Prefix:MR
First Name:ELANGO
Middle Name:S
Last Name:RAMAIYAN
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 1:18126 29TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9308
Mailing Address - Country:US
Mailing Address - Phone:206-274-7585
Mailing Address - Fax:206-274-7585
Practice Address - Street 1:23475 NE NOVELTY HILL RD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5501
Practice Address - Country:US
Practice Address - Phone:425-636-0440
Practice Address - Fax:425-636-0443
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00054878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist