Provider Demographics
NPI:1629312871
Name:RAVIPATI, ANANDA KUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:ANANDA
Middle Name:KUMAR
Last Name:RAVIPATI
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 1:4 ROMAN KNOLL CT APT A
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-4030
Mailing Address - Country:US
Mailing Address - Phone:609-902-8780
Mailing Address - Fax:
Practice Address - Street 1:1251 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2665
Practice Address - Country:US
Practice Address - Phone:410-209-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist