Provider Demographics
NPI:1962014241
Name:VEMULA, SHARADA (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:SHARADA
Middle Name:
Last Name:VEMULA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1824
Mailing Address - Country:US
Mailing Address - Phone:860-781-7073
Mailing Address - Fax:
Practice Address - Street 1:1312 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1824
Practice Address - Country:US
Practice Address - Phone:860-781-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR2606183500000X
CTPCT0012886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist