Provider Demographics
NPI:1407178700
Name:MADDULA, SRINIVASU (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SRINIVASU
Middle Name:
Last Name:MADDULA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DAFFODIL DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3089
Mailing Address - Country:US
Mailing Address - Phone:732-841-5784
Mailing Address - Fax:
Practice Address - Street 1:5 DAFFODIL DR
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3089
Practice Address - Country:US
Practice Address - Phone:732-841-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03297400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03297400OtherPHARMACIST LICENSE NUMBER