Provider Demographics
NPI:1144697939
Name:SUDARSI, RAMAPRABHA (RPH)
Entity type:Individual
Prefix:
First Name:RAMAPRABHA
Middle Name:
Last Name:SUDARSI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 N COLONY DR APT 1D
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7120
Mailing Address - Country:US
Mailing Address - Phone:248-946-9450
Mailing Address - Fax:
Practice Address - Street 1:806 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-2171
Practice Address - Country:US
Practice Address - Phone:989-791-4221
Practice Address - Fax:989-791-6604
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist