Provider Demographics
NPI:1245969773
Name:RUDRARAJU, SURENDRA VARMA
Entity type:Individual
Prefix:MR
First Name:SURENDRA
Middle Name:VARMA
Last Name:RUDRARAJU
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 1:2001 COIT RD STE 310
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3764
Mailing Address - Country:US
Mailing Address - Phone:469-443-4488
Mailing Address - Fax:
Practice Address - Street 1:2001 COIT RD STE 310
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3764
Practice Address - Country:US
Practice Address - Phone:469-443-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist