Provider Demographics
NPI:1083077390
Name:PALADUGU, PUSHPALU
Entity Type:Individual
Prefix:
First Name:PUSHPALU
Middle Name:
Last Name:PALADUGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 LACKAWANNA ST APT 10-11
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-4232
Mailing Address - Country:US
Mailing Address - Phone:732-524-4224
Mailing Address - Fax:
Practice Address - Street 1:355 LACKAWANNA ST APT 10-11
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-4232
Practice Address - Country:US
Practice Address - Phone:732-524-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist