Provider Demographics
NPI:1790052777
Name:POTINENI, ANUPAMA
Entity Type:Individual
Prefix:
First Name:ANUPAMA
Middle Name:
Last Name:POTINENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7535 N GREENBAY RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-1871
Mailing Address - Country:US
Mailing Address - Phone:262-697-8927
Mailing Address - Fax:
Practice Address - Street 1:7535 N GREENBAY RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-1871
Practice Address - Country:US
Practice Address - Phone:262-697-8927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13879-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist