Provider Demographics
NPI:1932730264
Name:RAVICHANDRAN, VENKATARAMAN
Entity type:Individual
Prefix:
First Name:VENKATARAMAN
Middle Name:
Last Name:RAVICHANDRAN
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 1:900 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1222
Mailing Address - Country:US
Mailing Address - Phone:248-543-9940
Mailing Address - Fax:248-414-5756
Practice Address - Street 1:900 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1222
Practice Address - Country:US
Practice Address - Phone:248-543-9940
Practice Address - Fax:248-414-5756
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist