Provider Demographics
NPI:1649566266
Name:NAGIREDDY, NEELAKANTA RAO
Entity Type:Individual
Prefix:
First Name:NEELAKANTA RAO
Middle Name:
Last Name:NAGIREDDY
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 1:147 WIND BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-7481
Mailing Address - Country:US
Mailing Address - Phone:901-347-0301
Mailing Address - Fax:
Practice Address - Street 1:4212 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6424
Practice Address - Country:US
Practice Address - Phone:901-332-4997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31079183500000X
MSE010331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist