Provider Demographics
NPI:1366625758
Name:BUDHRAM, VISHNU (RPH)
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:
Last Name:BUDHRAM
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 1:8287 HOMELAWN ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2128
Mailing Address - Country:US
Mailing Address - Phone:718-657-6857
Mailing Address - Fax:
Practice Address - Street 1:9301 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4319
Practice Address - Country:US
Practice Address - Phone:718-558-0028
Practice Address - Fax:718-558-0859
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01540096Medicaid