Healthcare Provider Details

I. General information

NPI: 1881824753
Provider Name (Legal Business Name): MR. SENTHILVELAN RADHAKRISHNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 BROAD ST
DURHAM NC
27705-3314
US

IV. Provider business mailing address

1505 BROAD ST
DURHAM NC
27705-3314
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-4431
  • Fax: 919-286-2251
Mailing address:
  • Phone: 919-286-4431
  • Fax: 919-286-2251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: