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General NPI Number Information
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NPI Number | 1558066316
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Entity Type | Individual
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Provider Name | RATNA KUMAR KAMMULURI
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Gender | Male
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 149 DEMING ST
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City | MANCHESTER
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State | CT
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Zip | 06042-1731
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Country | US
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Telephone | 860-644-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 39 BUCKLAND ST APT 11133 BUILDING 11
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City | MANCHESTER
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State | CT
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Zip | 06042
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Country | US
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Telephone | 860-709-4566
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11909
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License Number State | CT
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