Provider Demographics
NPI:1992337109
Name:RAMADURAI, POMMISUBBASHINI
Entity type:Individual
Prefix:
First Name:POMMISUBBASHINI
Middle Name:
Last Name:RAMADURAI
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 1:14140 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2995
Mailing Address - Country:US
Mailing Address - Phone:313-867-5293
Mailing Address - Fax:
Practice Address - Street 1:14140 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2995
Practice Address - Country:US
Practice Address - Phone:313-867-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315116368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist