Provider Demographics
NPI:1588486385
Name:SRINIVASAN, RAMAN SANTOSH (PHARMD)
Entity type:Individual
Prefix:
First Name:RAMAN
Middle Name:SANTOSH
Last Name:SRINIVASAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5642
Mailing Address - Country:US
Mailing Address - Phone:734-620-6205
Mailing Address - Fax:
Practice Address - Street 1:1015 S SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5642
Practice Address - Country:US
Practice Address - Phone:989-839-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist