Provider Demographics
NPI:1316232358
Name:PUNNAVELIL, BINCY THOMAS (RPH)
Entity type:Individual
Prefix:
First Name:BINCY
Middle Name:THOMAS
Last Name:PUNNAVELIL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SAGAMORE TRCE
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4597
Mailing Address - Country:US
Mailing Address - Phone:615-585-5061
Mailing Address - Fax:
Practice Address - Street 1:104 SAGAMORE TRCE
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-585-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49596183500000X
TN33437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist