Provider Demographics
NPI:1891390456
Name:PALAKURTHI, SIVA KUMAR
Entity Type:Individual
Prefix:MR
First Name:SIVA KUMAR
Middle Name:
Last Name:PALAKURTHI
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 1:15395 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6478
Mailing Address - Country:US
Mailing Address - Phone:305-364-1143
Mailing Address - Fax:
Practice Address - Street 1:15395 NW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6478
Practice Address - Country:US
Practice Address - Phone:305-364-1143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist