Provider Demographics
NPI:1487937322
Name:GUNTUPALLI, ANIL BABU (MPHARM)
Entity type:Individual
Prefix:MR
First Name:ANIL
Middle Name:BABU
Last Name:GUNTUPALLI
Suffix:
Gender:M
Credentials:MPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 E BIG BEAVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2053
Mailing Address - Country:US
Mailing Address - Phone:248-526-0358
Mailing Address - Fax:248-526-0351
Practice Address - Street 1:1639 E BIG BEAVER RD STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2053
Practice Address - Country:US
Practice Address - Phone:248-526-0358
Practice Address - Fax:313-567-4295
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist