Provider Demographics
NPI:1689828402
Name:ANNAMANENI, RAVINDER RAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAVINDER
Middle Name:RAO
Last Name:ANNAMANENI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:RAVINDER
Other - Middle Name:RAO
Other - Last Name:ANNAMANENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1743 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4614
Mailing Address - Country:US
Mailing Address - Phone:212-234-7959
Mailing Address - Fax:212-234-7969
Practice Address - Street 1:1743 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4614
Practice Address - Country:US
Practice Address - Phone:212-234-7959
Practice Address - Fax:212-234-7969
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO2460400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist