Provider Demographics
NPI:1093115909
Name:ATMURI, SURYAKUMAR
Entity Type:Individual
Prefix:MR
First Name:SURYAKUMAR
Middle Name:
Last Name:ATMURI
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 1:1464 MERRILL PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2645
Mailing Address - Country:US
Mailing Address - Phone:650-207-7349
Mailing Address - Fax:
Practice Address - Street 1:1464 MERRILL PL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2645
Practice Address - Country:US
Practice Address - Phone:650-207-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA183500000OtherPHARMACIST