Provider Demographics
NPI:1598894081
Name:MATTUPALLI, PRASAD (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRASAD
Middle Name:
Last Name:MATTUPALLI
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 1:7571 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3716
Mailing Address - Country:US
Mailing Address - Phone:410-761-3443
Mailing Address - Fax:410-590-1986
Practice Address - Street 1:7571 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3716
Practice Address - Country:US
Practice Address - Phone:410-761-3443
Practice Address - Fax:410-590-1986
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist