Provider Demographics
NPI:1194328153
Name:MARURI, RAMACHANDRA
Entity type:Individual
Prefix:
First Name:RAMACHANDRA
Middle Name:
Last Name:MARURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 ARCTIC DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 STONEBROOK PKWY STE 112A
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75036-5317
Practice Address - Country:US
Practice Address - Phone:214-296-0040
Practice Address - Fax:214-960-2575
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist