Provider Demographics
NPI:1326451204
Name:BUTCHIREDDYGARI, PRASANNA LAKSHMI (CLINICAL PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PRASANNA
Middle Name:LAKSHMI
Last Name:BUTCHIREDDYGARI
Suffix:
Gender:F
Credentials:CLINICAL PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 YORK RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6014
Mailing Address - Country:US
Mailing Address - Phone:410-256-3342
Mailing Address - Fax:
Practice Address - Street 1:34 GUNFALLS GARTH
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4849
Practice Address - Country:US
Practice Address - Phone:785-239-7502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist