Provider Demographics
NPI:1003164013
Name:KORRAPATI, SAMBASIVA RAO
Entity Type:Individual
Prefix:MR
First Name:SAMBASIVA
Middle Name:RAO
Last Name:KORRAPATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5971 WEISS ST, #O-5
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2716
Mailing Address - Country:US
Mailing Address - Phone:954-369-1866
Mailing Address - Fax:
Practice Address - Street 1:147 W SAGINAW ST
Practice Address - Street 2:ADDRESS LINE 2
Practice Address - City:HEMLOCK
Practice Address - State:MI
Practice Address - Zip Code:48626-9541
Practice Address - Country:US
Practice Address - Phone:989-681-8285
Practice Address - Fax:989-642-5411
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist