Provider Demographics
NPI:1326638263
Name:YELLEPEDDI, VENKATA KASHYAP (RPH)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:KASHYAP
Last Name:YELLEPEDDI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 E QUAIL GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6562
Mailing Address - Country:US
Mailing Address - Phone:801-548-4343
Mailing Address - Fax:
Practice Address - Street 1:295 S CHIPETA WAY # 1S132
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1287
Practice Address - Country:US
Practice Address - Phone:801-548-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9534395-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9534395-1701OtherPHARMACIST LICENSE NUMBER