Provider Demographics
NPI:1295205375
Name:PAMIDIMUKKALA, PREETHI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PREETHI
Middle Name:
Last Name:PAMIDIMUKKALA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CHARLES E DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2745
Mailing Address - Country:US
Mailing Address - Phone:615-346-3866
Mailing Address - Fax:
Practice Address - Street 1:107 CHARLES E DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2745
Practice Address - Country:US
Practice Address - Phone:615-346-3866
Practice Address - Fax:615-727-0634
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist