Healthcare Provider Details

I. General information

NPI: 1003257346
Provider Name (Legal Business Name): VENKATA K VATTI R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17001 NEWBURGH RD
LIVONIA MI
48154-1610
US

IV. Provider business mailing address

2 BROOKFIELD WAY
PRINCETON JUNCTION NJ
08550-3509
US

V. Phone/Fax

Practice location:
  • Phone: 734-462-1707
  • Fax:
Mailing address:
  • Phone: 609-955-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3149593
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: