Provider Demographics
NPI:1972103638
Name:PULAKURTHI, SRIHARSHA
Entity Type:Individual
Prefix:
First Name:SRIHARSHA
Middle Name:
Last Name:PULAKURTHI
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 1:139 BOWERY LN
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3159
Mailing Address - Country:US
Mailing Address - Phone:603-988-8934
Mailing Address - Fax:
Practice Address - Street 1:270 INDIAN RUN ST
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-3706
Practice Address - Country:US
Practice Address - Phone:484-875-9587
Practice Address - Fax:484-875-9589
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist