Provider Demographics
NPI:1578881686
Name:DOPPALAPUDI, RAGHUNATH (RPH)
Entity Type:Individual
Prefix:MR
First Name:RAGHUNATH
Middle Name:
Last Name:DOPPALAPUDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:RAGHUNATH
Other - Middle Name:
Other - Last Name:DOPPALAPUDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 PATHMARK PLZ
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3518
Mailing Address - Country:US
Mailing Address - Phone:732-829-5089
Mailing Address - Fax:914-363-3942
Practice Address - Street 1:305 W GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-1815
Practice Address - Country:US
Practice Address - Phone:252-794-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO3214300183500000X
PARP444474183500000X
NY0569451183500000X
NC29191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist