Provider Demographics
NPI:1083625602
Name:GADIRAJU, RAMAKRISHNAM RAJU (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAMAKRISHNAM
Middle Name:RAJU
Last Name:GADIRAJU
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 1:447 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-2901
Mailing Address - Country:US
Mailing Address - Phone:973-482-7732
Mailing Address - Fax:973-482-9677
Practice Address - Street 1:447 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-2901
Practice Address - Country:US
Practice Address - Phone:973-482-7732
Practice Address - Fax:973-482-9677
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01623800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist