Provider Demographics
NPI:1689016230
Name:DAMARAJU, SRINIVAS (RPH)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:DAMARAJU
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 1:2152 E MAIN ST
Mailing Address - Street 2:EAST MAIN PHARMACY
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2603
Mailing Address - Country:US
Mailing Address - Phone:203-755-7200
Mailing Address - Fax:203-755-7100
Practice Address - Street 1:2152 E MAIN ST
Practice Address - Street 2:EAST MAIN PHARMACY
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2603
Practice Address - Country:US
Practice Address - Phone:203-755-7200
Practice Address - Fax:203-755-7100
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist