Provider Demographics
NPI:1457630592
Name:VEMUGANTI, SHARATH CHANDRA (RPH)
Entity Type:Individual
Prefix:
First Name:SHARATH CHANDRA
Middle Name:
Last Name:VEMUGANTI
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 1:776 EVES DR
Mailing Address - Street 2:APT # 2B
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4950
Mailing Address - Country:US
Mailing Address - Phone:786-223-2922
Mailing Address - Fax:
Practice Address - Street 1:1343 E GUN HILL RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3010
Practice Address - Country:US
Practice Address - Phone:718-655-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist