Provider Demographics
NPI:1952502015
Name:PEDDI, KAVITHA
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:PEDDI
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 1:172 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:HI
Mailing Address - Zip Code:03053
Mailing Address - Country:US
Mailing Address - Phone:603-432-6580
Mailing Address - Fax:
Practice Address - Street 1:58 PLAISTOW RD
Practice Address - Street 2:
Practice Address - City:PLASTOW
Practice Address - State:NH
Practice Address - Zip Code:03865
Practice Address - Country:US
Practice Address - Phone:603-382-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist