Provider Demographics
NPI:1083932495
Name:MARURI, NAGESWARA REDDY (R PH)
Entity Type:Individual
Prefix:MR
First Name:NAGESWARA
Middle Name:REDDY
Last Name:MARURI
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3685
Mailing Address - Country:US
Mailing Address - Phone:973-736-4957
Mailing Address - Fax:
Practice Address - Street 1:8 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3685
Practice Address - Country:US
Practice Address - Phone:646-279-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032865183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032865OtherPHARMACIST