Provider Demographics
NPI:1295037604
Name:NERAVETLA, RAMAKRISHNA R (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAMAKRISHNA
Middle Name:R
Last Name:NERAVETLA
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 1:72 E 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8203
Mailing Address - Country:US
Mailing Address - Phone:804-869-9303
Mailing Address - Fax:
Practice Address - Street 1:72 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8203
Practice Address - Country:US
Practice Address - Phone:804-869-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004090183500000X
VA0202206561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist