Provider Demographics
NPI:1992386981
Name:JULURU, VENKATA L N
Entity Type:Individual
Prefix:DR
First Name:VENKATA L N
Middle Name:
Last Name:JULURU
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 1:274 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:ELLERBE
Mailing Address - State:NC
Mailing Address - Zip Code:28338
Mailing Address - Country:US
Mailing Address - Phone:910-652-6261
Mailing Address - Fax:910-652-2469
Practice Address - Street 1:274 SECOND STREET
Practice Address - Street 2:
Practice Address - City:ELLERBE
Practice Address - State:NC
Practice Address - Zip Code:28338
Practice Address - Country:US
Practice Address - Phone:910-652-6261
Practice Address - Fax:910-652-2469
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC29079OtherNORTH CAROLINA BOARD OF PHARMACY