Provider Demographics
NPI:1144575713
Name:MALLADI, SRINIVASA RAO (RPH)
Entity Type:Individual
Prefix:MR
First Name:SRINIVASA RAO
Middle Name:
Last Name:MALLADI
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 1:1511 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-4004
Mailing Address - Country:US
Mailing Address - Phone:609-716-9130
Mailing Address - Fax:
Practice Address - Street 1:350 ROUTE 130
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2715
Practice Address - Country:US
Practice Address - Phone:609-443-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03275500183500000X
NY056502-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist