Provider Demographics
NPI:1174853840
Name:PURI, RAVINDER
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:
Last Name:PURI
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 1:5655 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-5517
Mailing Address - Country:US
Mailing Address - Phone:360-384-1551
Mailing Address - Fax:
Practice Address - Street 1:1225 E SUNSET DR
Practice Address - Street 2:110
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3597
Practice Address - Country:US
Practice Address - Phone:360-384-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00071843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist