Provider Demographics
NPI:1114466141
Name:SATLAPALLI, GOPINATH
Entity Type:Individual
Prefix:
First Name:GOPINATH
Middle Name:
Last Name:SATLAPALLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:GREECE
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4116
Mailing Address - Country:US
Mailing Address - Phone:631-312-1294
Mailing Address - Fax:
Practice Address - Street 1:2542 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:GREECE
Practice Address - State:NY
Practice Address - Zip Code:14626-4116
Practice Address - Country:US
Practice Address - Phone:585-685-8013
Practice Address - Fax:585-685-8189
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68258183500000X
NJ28RI03691000183500000X
NYI066444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist