=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144697939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMAPRABHA SUDARSI RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2015
-----------------------------------------------------
Last Update Date | 08/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 806 GRATIOT AVE
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-791-4221
-----------------------------------------------------
Fax | 989-791-6604
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 N COLONY DR APT 1D
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48638-7120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-946-9450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302040409
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------