Provider Demographics
NPI:1396034203
Name:KANAKAMEDALA, SRIKAVITHA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SRIKAVITHA
Middle Name:
Last Name:KANAKAMEDALA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1073
Mailing Address - Country:US
Mailing Address - Phone:908-444-3491
Mailing Address - Fax:
Practice Address - Street 1:66 E GLENWOOD AVE
Practice Address - Street 2:RITE AID
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977
Practice Address - Country:US
Practice Address - Phone:302-653-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist