Provider Demographics
NPI:1447586185
Name:KANDI, SIRISHA (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:SIRISHA
Middle Name:
Last Name:KANDI
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 1:968 CONDOR DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-5985
Mailing Address - Country:US
Mailing Address - Phone:972-652-0195
Mailing Address - Fax:
Practice Address - Street 1:3230 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210-2417
Practice Address - Country:US
Practice Address - Phone:214-421-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36978183500000X
NJ28RI03002800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist