Individual
REVATHI KODALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3860 S 27TH ST, MILWAUKEE, WI 53221-1307
(414) 282-7557
Mailing address
3860 S 27TH ST, MILWAUKEE, WI 53221-1307
(414) 282-7557
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21178-40
WI
Other
Enumeration date
01/02/2022
Last updated
01/02/2022
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