Provider Demographics
NPI:1003257346
Name:VATTI, VENKATA K (RPH)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:K
Last Name:VATTI
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 1:2 BROOKFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-3509
Mailing Address - Country:US
Mailing Address - Phone:609-955-4004
Mailing Address - Fax:
Practice Address - Street 1:17001 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1610
Practice Address - Country:US
Practice Address - Phone:734-462-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3149593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist