Provider Demographics
NPI:1902226764
Name:GERA, PRAKASH SATYA-MURTHY (RPH)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:SATYA-MURTHY
Last Name:GERA
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 1:28783 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-4152
Mailing Address - Country:US
Mailing Address - Phone:586-522-4334
Mailing Address - Fax:586-920-2678
Practice Address - Street 1:28783 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4152
Practice Address - Country:US
Practice Address - Phone:586-522-4334
Practice Address - Fax:586-920-2678
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist