Provider Demographics
NPI:1124351838
Name:TALLURI, JOSEPH PRAVEEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PRAVEEN
Last Name:TALLURI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 SWEET WOODRUFF LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5606
Mailing Address - Country:US
Mailing Address - Phone:704-813-1941
Mailing Address - Fax:
Practice Address - Street 1:6802 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-6204
Practice Address - Country:US
Practice Address - Phone:704-829-5681
Practice Address - Fax:704-829-5687
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-13
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11578183500000X
NC18697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist