Provider Demographics
NPI:1992017651
Name:MANDADI, SWETHA REDDY (RPH)
Entity Type:Individual
Prefix:
First Name:SWETHA
Middle Name:REDDY
Last Name:MANDADI
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 1:285 VAN MAR DR
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4136
Mailing Address - Country:US
Mailing Address - Phone:732-618-3965
Mailing Address - Fax:
Practice Address - Street 1:4250 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6498
Practice Address - Country:US
Practice Address - Phone:770-565-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist