Provider Demographics
NPI:1588091078
Name:DRAKSHAPALLY, RAVI (RPH)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:DRAKSHAPALLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 E 149TH ST
Mailing Address - Street 2:PHARMORE PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5688
Mailing Address - Country:US
Mailing Address - Phone:646-314-7954
Mailing Address - Fax:646-314-7954
Practice Address - Street 1:337 E 149TH ST
Practice Address - Street 2:PHARMORE PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5688
Practice Address - Country:US
Practice Address - Phone:646-314-7954
Practice Address - Fax:646-314-7954
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03483000183500000X
NY058775183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist