Provider Demographics
NPI:1437401189
Name:PANCHALINGALA, SRIKANTH GOUD (RPH)
Entity Type:Individual
Prefix:MR
First Name:SRIKANTH GOUD
Middle Name:
Last Name:PANCHALINGALA
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 1:2402 N GRIMES ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-2109
Mailing Address - Country:US
Mailing Address - Phone:575-392-4503
Mailing Address - Fax:
Practice Address - Street 1:2402 N GRIMES ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2109
Practice Address - Country:US
Practice Address - Phone:575-392-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist