Provider Demographics
NPI:1184099939
Name:PRATIVADI, VENKATA SRIVIDYA
Entity type:Individual
Prefix:MRS
First Name:VENKATA SRIVIDYA
Middle Name:
Last Name:PRATIVADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SHADY PINE LN
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1541
Mailing Address - Country:US
Mailing Address - Phone:248-882-8140
Mailing Address - Fax:
Practice Address - Street 1:531 W GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5515
Practice Address - Country:US
Practice Address - Phone:989-753-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302041654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist