Provider Demographics
NPI:1346594488
Name:KONDABATHINI, RADHIKA RANI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:RADHIKA
Middle Name:RANI
Last Name:KONDABATHINI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MRS
Other - First Name:RADHIKA
Other - Middle Name:RANI
Other - Last Name:PULIPATI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3659 BYRON CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7835
Mailing Address - Country:US
Mailing Address - Phone:240-422-1986
Mailing Address - Fax:
Practice Address - Street 1:3659 BYRON CIR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7835
Practice Address - Country:US
Practice Address - Phone:240-422-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD170151835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy