Provider Demographics
NPI:1578829941
Name:CHERUKURI, SHALENDRA (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHALENDRA
Middle Name:
Last Name:CHERUKURI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 DANIELS PURCHASE WAY
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1599
Mailing Address - Country:US
Mailing Address - Phone:410-758-1715
Mailing Address - Fax:
Practice Address - Street 1:102 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1116
Practice Address - Country:US
Practice Address - Phone:410-758-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist