Provider Demographics
NPI:1477838027
Name:NELLURI, LAKSHMI D (MASTERS IN PHARMACY)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:D
Last Name:NELLURI
Suffix:
Gender:F
Credentials:MASTERS IN PHARMACY
Other - Prefix:
Other - First Name:LAKSHMI
Other - Middle Name:D
Other - Last Name:TAMMAREDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:24598 VERDANT DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-2124
Mailing Address - Country:US
Mailing Address - Phone:248-476-0192
Mailing Address - Fax:
Practice Address - Street 1:24100 NOVI RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3247
Practice Address - Country:US
Practice Address - Phone:248-349-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302034945OtherPARMACIST LICENCE NUMBER