Provider Demographics
NPI:1356631485
Name:ACHURI, VINAY KUMAR (BS)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:KUMAR
Last Name:ACHURI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8398 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7451
Mailing Address - Country:US
Mailing Address - Phone:810-252-3783
Mailing Address - Fax:
Practice Address - Street 1:521 N STATE RD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1311
Practice Address - Country:US
Practice Address - Phone:810-658-0527
Practice Address - Fax:810-658-0897
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist