Provider Demographics
NPI:1639476096
Name:JANNAPALLY, SURESH REDDY (RPH)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:REDDY
Last Name:JANNAPALLY
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 1:14607 FARNHAM LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13929 BALTIMORE AVE
Practice Address - Street 2:SUITE#4
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5045
Practice Address - Country:US
Practice Address - Phone:301-490-8311
Practice Address - Fax:301-490-8244
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19034183500000X
NH3604183500000X
NY055323183500000X, 183500000X
DEA1-0004012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist