Provider Demographics
NPI:1235303694
Name:VENISETTY, PRAVEEN KUMAR
Entity Type:Individual
Prefix:
First Name:PRAVEEN
Middle Name:KUMAR
Last Name:VENISETTY
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 1:9110 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-1146
Mailing Address - Country:US
Mailing Address - Phone:810-635-4481
Mailing Address - Fax:
Practice Address - Street 1:9110 MILLER RD
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-1146
Practice Address - Country:US
Practice Address - Phone:810-635-4481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist