Provider Demographics
NPI:1972851590
Name:PADMANABHUNI, AMAR VENKATA NAGA (MS RPH)
Entity Type:Individual
Prefix:MR
First Name:AMAR
Middle Name:VENKATA NAGA
Last Name:PADMANABHUNI
Suffix:
Gender:M
Credentials:MS RPH
Other - Prefix:
Other - First Name:VENKATA
Other - Middle Name:NAGA AMAR
Other - Last Name:PADMANABHONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2714 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2568
Mailing Address - Country:US
Mailing Address - Phone:302-791-9899
Mailing Address - Fax:302-319-3449
Practice Address - Street 1:2714 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2568
Practice Address - Country:US
Practice Address - Phone:302-791-9899
Practice Address - Fax:302-319-3449
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004128183500000X
MD16816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist