Provider Demographics
NPI:1861821175
Name:MELGIRI, RAGHAVENDRA
Entity Type:Individual
Prefix:MR
First Name:RAGHAVENDRA
Middle Name:
Last Name:MELGIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 SHIREWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-7064
Mailing Address - Country:US
Mailing Address - Phone:989-948-4197
Mailing Address - Fax:
Practice Address - Street 1:1615 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7237
Practice Address - Country:US
Practice Address - Phone:989-832-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist