Provider Demographics
NPI:1427392893
Name:VEMULAPALLI, VENKATA S (RPH)
Entity Type:Individual
Prefix:
First Name:VENKATA
Middle Name:S
Last Name:VEMULAPALLI
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 1:309 W MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-2133
Mailing Address - Country:US
Mailing Address - Phone:480-632-1244
Mailing Address - Fax:
Practice Address - Street 1:1245 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-7018
Practice Address - Country:US
Practice Address - Phone:480-833-8838
Practice Address - Fax:480-833-8749
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist