Healthcare Provider Details

I. General information

NPI: 1386718211
Provider Name (Legal Business Name): RAMA D MADDUKURI R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HARBESON CT
MONTVILLE NJ
07045-8927
US

IV. Provider business mailing address

7 HARBESON CT
MONTVILLE NJ
07045-8927
US

V. Phone/Fax

Practice location:
  • Phone: 973-439-0395
  • Fax: 973-439-0396
Mailing address:
  • Phone: 973-439-0395
  • Fax: 973-439-0396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02381500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: