Provider Demographics
NPI:1972803963
Name:MITTAPELLY, NAGAMANI (RPH)
Entity Type:Individual
Prefix:
First Name:NAGAMANI
Middle Name:
Last Name:MITTAPELLY
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 1:2304 HUNTERS WOODS PLZ
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-2811
Mailing Address - Country:US
Mailing Address - Phone:703-716-4203
Mailing Address - Fax:703-716-3285
Practice Address - Street 1:13588 FLYING SQUIRREL DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-5003
Practice Address - Country:US
Practice Address - Phone:571-263-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist