Provider Demographics
NPI:1679872865
Name:MUDUNURI, UMA VALLI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:UMA
Middle Name:VALLI
Last Name:MUDUNURI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BLACK CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7627
Mailing Address - Country:US
Mailing Address - Phone:269-660-0535
Mailing Address - Fax:
Practice Address - Street 1:30 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3737
Practice Address - Country:US
Practice Address - Phone:269-965-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist