Provider Demographics
NPI:1699001933
Name:PALLAPOLU, NAGI REDDY
Entity Type:Individual
Prefix:
First Name:NAGI
Middle Name:REDDY
Last Name:PALLAPOLU
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 1:2650 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4126
Mailing Address - Country:US
Mailing Address - Phone:718-777-1100
Mailing Address - Fax:718-777-5276
Practice Address - Street 1:2650 4TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4126
Practice Address - Country:US
Practice Address - Phone:718-777-1100
Practice Address - Fax:718-777-5276
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPENDING183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist