Provider Demographics
NPI:1205283256
Name:GUJJULA, RAMANARASIMHA REDDY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RAMANARASIMHA
Middle Name:REDDY
Last Name:GUJJULA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 GRATIOT RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6030
Mailing Address - Country:US
Mailing Address - Phone:989-249-4215
Mailing Address - Fax:989-249-4215
Practice Address - Street 1:5050 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6030
Practice Address - Country:US
Practice Address - Phone:989-249-4215
Practice Address - Fax:989-249-4215
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist