Provider Demographics
NPI:1043466527
Name:GOTTIPATI, SATHEESH S (RPH)
Entity Type:Individual
Prefix:MR
First Name:SATHEESH
Middle Name:S
Last Name:GOTTIPATI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E LANCASTER AVE
Mailing Address - Street 2:APT.# C-2
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4228
Mailing Address - Country:US
Mailing Address - Phone:267-283-1245
Mailing Address - Fax:267-283-1245
Practice Address - Street 1:500 CHESTERBROOK BLVD STE B11
Practice Address - Street 2:RITEAID PHARMACY
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5645
Practice Address - Country:US
Practice Address - Phone:610-647-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist