Provider Demographics
NPI:1184931537
Name:POTLURI, SYAM KUMAR (BPHARM)
Entity type:Individual
Prefix:MR
First Name:SYAM
Middle Name:KUMAR
Last Name:POTLURI
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 WINELEAF CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-5401
Mailing Address - Country:US
Mailing Address - Phone:410-628-4190
Mailing Address - Fax:410-628-1493
Practice Address - Street 1:6918 RIDGE RD STE 6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3894
Practice Address - Country:US
Practice Address - Phone:410-574-1440
Practice Address - Fax:410-574-1970
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist