Provider Demographics
NPI:1417554882
Name:AMIPARA, RAVINDRAKUMAR G (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:RAVINDRAKUMAR
Middle Name:G
Last Name:AMIPARA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 INDEPENDENCE PKWY APT 1522
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-8237
Mailing Address - Country:US
Mailing Address - Phone:214-516-4871
Mailing Address - Fax:
Practice Address - Street 1:3201 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2430
Practice Address - Country:US
Practice Address - Phone:214-516-4871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist