Provider Demographics
NPI:1205286424
Name:RAPURU, SIVA KUMAR
Entity type:Individual
Prefix:
First Name:SIVA KUMAR
Middle Name:
Last Name:RAPURU
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 1:1115 SILAS CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-5627
Mailing Address - Country:US
Mailing Address - Phone:336-725-8513
Mailing Address - Fax:336-722-0733
Practice Address - Street 1:1115 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5627
Practice Address - Country:US
Practice Address - Phone:336-725-8513
Practice Address - Fax:336-722-0733
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist