Provider Demographics
NPI:1902451271
Name:ALLURI, RAVINDRANADHA RAJU
Entity Type:Individual
Prefix:
First Name:RAVINDRANADHA
Middle Name:RAJU
Last Name:ALLURI
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 1:23020 POWER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3247
Mailing Address - Country:US
Mailing Address - Phone:248-987-6141
Mailing Address - Fax:
Practice Address - Street 1:23020 POWER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3247
Practice Address - Country:US
Practice Address - Phone:248-987-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist