Provider Demographics
NPI:1649467945
Name:SHIVAKUMAR, SRIKANTH M (RPH)
Entity type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:M
Last Name:SHIVAKUMAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 WYNNELEAF ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8144
Mailing Address - Country:US
Mailing Address - Phone:614-397-6687
Mailing Address - Fax:206-600-4206
Practice Address - Street 1:2831 WYNNELEAF ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8144
Practice Address - Country:US
Practice Address - Phone:614-397-6687
Practice Address - Fax:206-600-4206
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03128002183500000X
MI5302037600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist