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NPI Code Detail

MEDICARE: SRINIVASA V PRASAD IVATURI R.PH

MEDICARE: SRINIVASA V PRASAD IVATURI R.PH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist28RI03424500NJ

General Provider Information

NPI Number : 1740568773
Entity Type Code : Individual
Provider Name (Legal Business Name) : SRINIVASA V PRASAD IVATURI R.PH
Provider Business Mailing Address
First Line : 136 CYPRUS LN
Second Line :
City : COATESVILLE
State : PA
Zip : 19320-4547
Country : US
Telephone Number : 215-688-2733
Fax Number : 856-935-4900
Provider Business Practice Location Address
First Line : 228 E BROADWAY
Second Line :
City : SALEM
State : NJ
Zip : 08079-1108
Country : US
Telephone Number : 856-935-4800
Fax Number : 856-935-4900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2011
Last Update Date : 07/25/2011

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