Provider Demographics
NPI:1477168698
Name:MAMILLAPALLI, HARIBABU
Entity Type:Individual
Prefix:MR
First Name:HARIBABU
Middle Name:
Last Name:MAMILLAPALLI
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 1:7149 SPRING LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1672
Mailing Address - Country:US
Mailing Address - Phone:989-395-5622
Mailing Address - Fax:
Practice Address - Street 1:920 N JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6291
Practice Address - Country:US
Practice Address - Phone:989-892-4531
Practice Address - Fax:989-892-0946
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist