Provider Demographics
NPI:1447565015
Name:VEMPATI, BALAKRISHNA
Entity Type:Individual
Prefix:MR
First Name:BALAKRISHNA
Middle Name:
Last Name:VEMPATI
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 1:4350 RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-2712
Mailing Address - Country:US
Mailing Address - Phone:423-867-1978
Mailing Address - Fax:423-867-7658
Practice Address - Street 1:4350 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-2712
Practice Address - Country:US
Practice Address - Phone:423-867-1978
Practice Address - Fax:423-867-7658
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2010-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist