Provider Demographics
NPI:1740557347
Name:KALUVALA, PRAVEEN R (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRAVEEN
Middle Name:R
Last Name:KALUVALA
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 1:2710 S CLEAR CREEK RD APT 113
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6686
Mailing Address - Country:US
Mailing Address - Phone:254-781-2400
Mailing Address - Fax:
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:APT B
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940
Practice Address - Country:US
Practice Address - Phone:973-377-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-27
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03470800183500000X
TX55990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18350OtherPHARMACIST