Provider Demographics
NPI:1629678487
Name:MALLADI, AMARNATH REDDY
Entity Type:Individual
Prefix:
First Name:AMARNATH
Middle Name:REDDY
Last Name:MALLADI
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 1:2031 CREEKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2651
Mailing Address - Country:US
Mailing Address - Phone:804-787-0964
Mailing Address - Fax:
Practice Address - Street 1:900 WALMART WAY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2600
Practice Address - Country:US
Practice Address - Phone:804-378-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist