Provider Demographics
NPI:1639469943
Name:YERIKALAPUDI, SIDDHARTHA PADMAPANI
Entity Type:Individual
Prefix:MR
First Name:SIDDHARTHA
Middle Name:PADMAPANI
Last Name:YERIKALAPUDI
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 1:1240 PEBBLEBROOKE LN
Mailing Address - Street 2:# 101
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7173
Mailing Address - Country:US
Mailing Address - Phone:540-886-2076
Mailing Address - Fax:
Practice Address - Street 1:101 ROSSER AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3510
Practice Address - Country:US
Practice Address - Phone:540-942-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist