Provider Demographics
NPI:1669035085
Name:KOLLUR, VENKATA RAMANAMURTHY
Entity Type:Individual
Prefix:
First Name:VENKATA RAMANAMURTHY
Middle Name:
Last Name:KOLLUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 HELSINKI CRESC
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9G3G2
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4609 HELSINKI CRESC
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:ONTARIO
Practice Address - Zip Code:N9G3G2
Practice Address - Country:CA
Practice Address - Phone:248-880-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist