MEDICARE: MR. RAMAKRISHNA R NERAVETLA R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	A1-0004090	DE
2	183500000X	Pharmacist	0202206561	VA

General Provider Information

NPI Number	:	1295037604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAMAKRISHNA R NERAVETLA R.PH

Provider Business Mailing Address
First Line	:	72 E 167TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8203
Country	:	US
Telephone Number	:	804-869-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 E 167TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8203
Country	:	US
Telephone Number	:	804-869-9303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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