Provider Demographics
NPI:1972814515
Name:YALAMANCHILI, RAVICHAND
Entity type:Individual
Prefix:MR
First Name:RAVICHAND
Middle Name:
Last Name:YALAMANCHILI
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 1:424 REGENCY DR
Mailing Address - Street 2:# 301
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:910-484-2170
Mailing Address - Fax:910-321-9578
Practice Address - Street 1:2605 RAEFORD RD
Practice Address - Street 2:RTIE AID PHARMACY-11503
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-484-2170
Practice Address - Fax:910-321-9578
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBR5298054OtherPHARMACY DEA NUMBER