Provider Demographics
NPI:1154650141
Name:NANDIRAJU, SANTHISREE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SANTHISREE
Middle Name:
Last Name:NANDIRAJU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 YAKIMA PL SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-7063
Mailing Address - Country:US
Mailing Address - Phone:425-829-9277
Mailing Address - Fax:
Practice Address - Street 1:25605 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7609
Practice Address - Country:US
Practice Address - Phone:253-813-6968
Practice Address - Fax:253-813-8868
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067161183500000X
FLPS39899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist