Provider Demographics
NPI:1972894012
Name:THULLURI, SUNEELA (RPH)
Entity Type:Individual
Prefix:
First Name:SUNEELA
Middle Name:
Last Name:THULLURI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 SCENIC PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29696-2536
Mailing Address - Country:US
Mailing Address - Phone:864-638-3976
Mailing Address - Fax:864-638-9723
Practice Address - Street 1:180 SCENIC PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:SC
Practice Address - Zip Code:29696-2536
Practice Address - Country:US
Practice Address - Phone:864-638-3976
Practice Address - Fax:864-638-9723
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist