Provider Demographics
NPI:1376871848
Name:TATINENI, DINAKAR
Entity Type:Individual
Prefix:MR
First Name:DINAKAR
Middle Name:
Last Name:TATINENI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8530 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2614
Practice Address - Country:US
Practice Address - Phone:425-348-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-22
Last Update Date:2013-08-07
Deactivation Date:2010-07-21
Deactivation Code:
Reactivation Date:2013-08-07
Provider Licenses
StateLicense IDTaxonomies
WAPH60041956183500000X
AZS016552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist