Provider Demographics
NPI:1730665548
Name:DUNDOO, RAVI
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:
Last Name:DUNDOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RAVI
Other - Middle Name:
Other - Last Name:DUNDOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:15425 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3077
Mailing Address - Country:US
Mailing Address - Phone:636-256-7922
Mailing Address - Fax:636-256-6998
Practice Address - Street 1:15425 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3077
Practice Address - Country:US
Practice Address - Phone:636-256-7922
Practice Address - Fax:636-256-6998
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist