Provider Demographics
NPI:1003381625
Name:KONERU, VARAPRASAD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:VARAPRASAD
Middle Name:
Last Name:KONERU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1602
Mailing Address - Country:US
Mailing Address - Phone:989-758-6000
Mailing Address - Fax:
Practice Address - Street 1:316 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1602
Practice Address - Country:US
Practice Address - Phone:989-758-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302038489OtherBOARD OF PHARMACY