Provider Demographics
NPI:1801194030
Name:TATIKONDA, RAVIKIRAN KUMAR (RPH)
Entity Type:Individual
Prefix:
First Name:RAVIKIRAN
Middle Name:KUMAR
Last Name:TATIKONDA
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 1:202 CHRISTIANA MDWS
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2802
Mailing Address - Country:US
Mailing Address - Phone:302-743-3764
Mailing Address - Fax:
Practice Address - Street 1:1580 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4900
Practice Address - Country:US
Practice Address - Phone:302-734-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-003697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist