Provider Demographics
NPI:1457068017
Name:MUSUNURU, NAMRATHA
Entity Type:Individual
Prefix:
First Name:NAMRATHA
Middle Name:
Last Name:MUSUNURU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8785 KEYSTONE XING
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2337
Mailing Address - Country:US
Mailing Address - Phone:646-724-6284
Mailing Address - Fax:
Practice Address - Street 1:6101 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2488
Practice Address - Country:US
Practice Address - Phone:317-454-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029652A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist