Provider Demographics
NPI:1790096337
Name:KAMINENI, SIVA KUMAR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SIVA KUMAR
Middle Name:
Last Name:KAMINENI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 W LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-4128
Mailing Address - Country:US
Mailing Address - Phone:480-539-5905
Mailing Address - Fax:
Practice Address - Street 1:4502 E OAK ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-2411
Practice Address - Country:US
Practice Address - Phone:602-808-0111
Practice Address - Fax:602-808-0115
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist