Provider Demographics
NPI:1184947699
Name:KALLURY, ANANTHA P (RPH)
Entity type:Individual
Prefix:MR
First Name:ANANTHA
Middle Name:P
Last Name:KALLURY
Suffix:
Gender:M
Credentials:RPH
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Other - Credentials:
Mailing Address - Street 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:BRONX LEBANON HOSPITAL CENTER ,DEP. OF PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-518-5020
Mailing Address - Fax:718-518-5298
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:BRONX LEBANON HOSPITAL CENTER ,PHARMACY DEPARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-518-5020
Practice Address - Fax:718-518-5298
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY032117282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital