Provider Demographics
NPI:1588119630
Name:RAVIM PHARMACEUTICALS
Entity type:Organization
Organization Name:RAVIM PHARMACEUTICALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UMAMAHESWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIPURAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-586-6959
Mailing Address - Street 1:5259 RODMAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1528
Mailing Address - Country:US
Mailing Address - Phone:215-921-9346
Mailing Address - Fax:215-921-9337
Practice Address - Street 1:5259 RODMAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1528
Practice Address - Country:US
Practice Address - Phone:215-921-9346
Practice Address - Fax:215-921-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4826953336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2163708OtherPK
PA1032363970001Medicaid