Provider Demographics
NPI:1265845853
Name:MALIREDDY, MADHULATHA REDDY
Entity Type:Individual
Prefix:
First Name:MADHULATHA
Middle Name:REDDY
Last Name:MALIREDDY
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 1:12 BLOCK AVE
Mailing Address - Street 2:APT 32
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-5149
Mailing Address - Country:US
Mailing Address - Phone:404-704-0854
Mailing Address - Fax:
Practice Address - Street 1:2 CHESTER RD
Practice Address - Street 2:SUITE 25 SPRINGFIELD PLAZA
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2957
Practice Address - Country:US
Practice Address - Phone:802-885-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0003879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist