Provider Demographics
NPI:1528367240
Name:SONTINENI, SREEDHAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SREEDHAR
Middle Name:
Last Name:SONTINENI
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 1:35261 DRAKESHIRE LN
Mailing Address - Street 2:APT 204
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3246
Mailing Address - Country:US
Mailing Address - Phone:901-212-4216
Mailing Address - Fax:
Practice Address - Street 1:1124 N BALLENGER HWY
Practice Address - Street 2:C/O RITEAID PHARMACY
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-7516
Practice Address - Country:US
Practice Address - Phone:810-233-6765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist