Provider Demographics
NPI:1073828000
Name:SHENKESHI, SURESH KUMAR
Entity Type:Individual
Prefix:
First Name:SURESH KUMAR
Middle Name:
Last Name:SHENKESHI
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 1:12965 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9594
Mailing Address - Country:US
Mailing Address - Phone:520-825-4531
Mailing Address - Fax:520-825-4531
Practice Address - Street 1:12965 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9594
Practice Address - Country:US
Practice Address - Phone:520-825-4531
Practice Address - Fax:520-825-4531
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist