Provider Demographics
NPI:1881824753
Name:RADHAKRISHNAN, SENTHILVELAN
Entity Type:Individual
Prefix:MR
First Name:SENTHILVELAN
Middle Name:
Last Name:RADHAKRISHNAN
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 1:1505 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3314
Mailing Address - Country:US
Mailing Address - Phone:919-286-4431
Mailing Address - Fax:919-286-2251
Practice Address - Street 1:1505 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3314
Practice Address - Country:US
Practice Address - Phone:919-286-4431
Practice Address - Fax:919-286-2251
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17430183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist