Provider Demographics
NPI:1063645331
Name:BOMPELLI, RANJITH KUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:RANJITH
Middle Name:KUMAR
Last Name:BOMPELLI
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 1:5270 DEALE-CHURCHTON ROAD
Mailing Address - Street 2:
Mailing Address - City:DEALE
Mailing Address - State:MD
Mailing Address - Zip Code:20751
Mailing Address - Country:US
Mailing Address - Phone:410-867-2500
Mailing Address - Fax:
Practice Address - Street 1:5720 DEALE CHURCHTON RD
Practice Address - Street 2:
Practice Address - City:DEALE
Practice Address - State:MD
Practice Address - Zip Code:20751-9756
Practice Address - Country:US
Practice Address - Phone:410-867-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18Medicaid