Provider Demographics
NPI:1124315403
Name:DEVENDRAN, EMANUELA ANTONETA
Entity type:Individual
Prefix:MRS
First Name:EMANUELA
Middle Name:ANTONETA
Last Name:DEVENDRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46327-1411
Mailing Address - Country:US
Mailing Address - Phone:219-932-2007
Mailing Address - Fax:
Practice Address - Street 1:4445 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46327-1411
Practice Address - Country:US
Practice Address - Phone:219-932-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040380183500000X
IN26030730A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist