Provider Demographics
NPI:1538489836
Name:RAMINENI, MADHURI
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:RAMINENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33A GRACE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-1244
Mailing Address - Country:US
Mailing Address - Phone:973-707-6830
Mailing Address - Fax:
Practice Address - Street 1:435 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2356
Practice Address - Country:US
Practice Address - Phone:973-546-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03087700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist