Provider Demographics
NPI:1578866091
Name:ANUGU, RAVI (B PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:
Last Name:ANUGU
Suffix:
Gender:M
Credentials:B PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5936
Mailing Address - Country:US
Mailing Address - Phone:850-322-4749
Mailing Address - Fax:
Practice Address - Street 1:32 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5936
Practice Address - Country:US
Practice Address - Phone:850-322-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20055253183500000X
FLPS39556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist