Provider Demographics
NPI:1174871032
Name:BANDI, RAVIPRASAD
Entity type:Individual
Prefix:
First Name:RAVIPRASAD
Middle Name:
Last Name:BANDI
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 1:1575 CENTER AVE
Mailing Address - Street 2:APT#4B
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 CENTER AVE
Practice Address - Street 2:APT 4B
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4644
Practice Address - Country:US
Practice Address - Phone:862-591-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03221400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist