Provider Demographics
NPI:1902415938
Name:THOTAKURA, AKHILANDESWARI (RPH)
Entity Type:Individual
Prefix:
First Name:AKHILANDESWARI
Middle Name:
Last Name:THOTAKURA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 HIGHWAY 81 E
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-2914
Mailing Address - Country:US
Mailing Address - Phone:770-914-7748
Mailing Address - Fax:
Practice Address - Street 1:896 HIGHWAY 81 E
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-2914
Practice Address - Country:US
Practice Address - Phone:770-914-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist