Provider Demographics
NPI:1588974422
Name:KAVURI, KISHORE
Entity type:Individual
Prefix:MR
First Name:KISHORE
Middle Name:
Last Name:KAVURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-9000
Mailing Address - Country:US
Mailing Address - Phone:478-272-1210
Mailing Address - Fax:303-398-5266
Practice Address - Street 1:2103 VETERANS BLVD
Practice Address - Street 2:UNIT 2
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-7502
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:303-398-5266
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist