Provider Demographics
NPI:1225634686
Name:KASIREDDY, JYOTHIRMAI R
Entity Type:Individual
Prefix:
First Name:JYOTHIRMAI
Middle Name:R
Last Name:KASIREDDY
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 1:16 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-5216
Mailing Address - Country:US
Mailing Address - Phone:603-738-4598
Mailing Address - Fax:
Practice Address - Street 1:952 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2017
Practice Address - Country:US
Practice Address - Phone:603-934-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist