Provider Demographics
NPI:1073845137
Name:BHUPATHIRAJU, VENKATA SATYA
Entity Type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:SATYA
Last Name:BHUPATHIRAJU
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 1:1618 GOLDRUSH RD APT 241
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8390
Mailing Address - Country:US
Mailing Address - Phone:928-234-2686
Mailing Address - Fax:
Practice Address - Street 1:2360 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7303
Practice Address - Country:US
Practice Address - Phone:928-763-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist