Healthcare Provider Details

I. General information

NPI: 1891947990
Provider Name (Legal Business Name): RAVINDRA KUDUR PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

588 CALEDONIA RD
DIX HILLS NY
11746-5123
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-2293
  • Fax:
Mailing address:
  • Phone: 631-549-0966
  • Fax: 631-761-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number035664-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: