Provider Demographics
NPI:1578830378
Name:ALLLANI, PRAMOD KUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:PRAMOD
Middle Name:KUMAR
Last Name:ALLLANI
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:N86W14326 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3266
Mailing Address - Country:US
Mailing Address - Phone:414-690-3160
Mailing Address - Fax:
Practice Address - Street 1:8488 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2111
Practice Address - Country:US
Practice Address - Phone:414-355-9402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14820-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist