Healthcare Provider Details

I. General information

NPI: 1942658638
Provider Name (Legal Business Name): RAMBABU KALAHASTHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 N ROCHESTER RD
ROCHESTER HILLS MI
48306-4341
US

IV. Provider business mailing address

3246 LOUIS DR
TROY MI
48083-5040
US

V. Phone/Fax

Practice location:
  • Phone: 248-651-1614
  • Fax:
Mailing address:
  • Phone: 248-635-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: