Provider Demographics
NPI:1245517713
Name:CHALLA, RAVI (PHARMD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:CHALLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 SW 184TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6251
Mailing Address - Country:US
Mailing Address - Phone:305-793-1468
Mailing Address - Fax:
Practice Address - Street 1:14901 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2238
Practice Address - Country:US
Practice Address - Phone:305-949-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist