Provider Demographics
NPI:1972736478
Name:VANMALI, RADHA S (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:RADHA
Middle Name:S
Last Name:VANMALI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:RADHA
Other - Middle Name:SATISH
Other - Last Name:VANMALI-PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3022 BONITA SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-9239
Mailing Address - Country:US
Mailing Address - Phone:404-414-1165
Mailing Address - Fax:
Practice Address - Street 1:1720 EPPS BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6132
Practice Address - Country:US
Practice Address - Phone:706-583-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist