Provider Demographics
NPI:1932934940
Name:MADDUKURI, LAKSHMI SWARUPARANI
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:SWARUPARANI
Last Name:MADDUKURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 RIVER RD APT B9
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-7510
Mailing Address - Country:US
Mailing Address - Phone:732-781-8812
Mailing Address - Fax:
Practice Address - Street 1:501 JERSEY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3457
Practice Address - Country:US
Practice Address - Phone:201-435-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04073100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist