Raja Avanadula
Individual provider Active NPI Pharmacist · Bonham, TX
NPI 1902189665 · NPPES record last updated May 6, 2020
Key facts
- NPI
- 1902189665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 013223 (KY)
- Practice address
- 2108 N Center St
Bonham, TX 75418-2628 - Phone
- (903) 583-8017
- NPI assigned
- Sep 20, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013223 | KY | MD | Pharmacist |
| 51172 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sai Drugs Inc | Current | Accepting new patients | |
| Sai Drugs Inc | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
2108 N Center St
Bonham, TX 75418
Phone (903) 583-8017
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 51172 | TX | |
| Pharmacist | 183500000X | 013223 | KY | Yes |
Addresses
Primary practice location
2108 N Center St
Bonham, TX 75418-2628
Mailing address
2108 N Center St
Bonham, TX 75418-2628
Phone (903) 583-8017
Other providers in Bonham, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.