Healthcare Provider Details

I. General information

NPI: 1801194030
Provider Name (Legal Business Name): RAVIKIRAN KUMAR TATIKONDA R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 S DUPONT HWY
DOVER DE
19901-4900
US

IV. Provider business mailing address

202 CHRISTIANA MDWS
BEAR DE
19701-2802
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-4788
  • Fax:
Mailing address:
  • Phone: 302-743-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-003697
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: