Provider Demographics
NPI:1760569321
Name:NADIPURAM, MOHAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAN
Middle Name:
Last Name:NADIPURAM
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 1:438 SOUTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705
Mailing Address - Country:US
Mailing Address - Phone:914-423-1003
Mailing Address - Fax:914-423-1083
Practice Address - Street 1:438 SOUTH BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705
Practice Address - Country:US
Practice Address - Phone:914-423-1003
Practice Address - Fax:914-423-1083
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033033OtherPHARMACY BOARD