Provider Demographics
NPI:1316355290
Name:YANALA, KRANTHI L (RPH)
Entity type:Individual
Prefix:
First Name:KRANTHI
Middle Name:L
Last Name:YANALA
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 1:5180 MADISON AVE
Mailing Address - Street 2:APT #B4
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5101
Mailing Address - Country:US
Mailing Address - Phone:985-817-9342
Mailing Address - Fax:
Practice Address - Street 1:5180 MADISON AVE
Practice Address - Street 2:APT #B4
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5101
Practice Address - Country:US
Practice Address - Phone:985-817-9342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist