Provider Demographics
NPI:1558444323
Name:CHERUKURI, SAI KRISHNA MOHAN
Entity Type:Individual
Prefix:MR
First Name:SAI
Middle Name:KRISHNA MOHAN
Last Name:CHERUKURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 CATALINA DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2363
Mailing Address - Country:US
Mailing Address - Phone:240-422-4778
Mailing Address - Fax:
Practice Address - Street 1:1860 STATE HWY 60 EAST
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853
Practice Address - Country:US
Practice Address - Phone:863-676-2266
Practice Address - Fax:863-678-1530
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0041509183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist