Provider Demographics
NPI:1467609628
Name:SRIPERAMBUDUR, DINESH
Entity Type:Individual
Prefix:
First Name:DINESH
Middle Name:
Last Name:SRIPERAMBUDUR
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 1:1733 TEXOMA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2613
Mailing Address - Country:US
Mailing Address - Phone:603-540-9492
Mailing Address - Fax:903-893-1702
Practice Address - Street 1:1733 TEXOMA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2613
Practice Address - Country:US
Practice Address - Phone:903-893-1700
Practice Address - Fax:903-893-1702
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3337OtherNEW HAMPSHIRE PHARMACIST LICENSE # 3337