Provider Demographics
NPI:1003817438
Name:JONNALA, RAMAMOHANA REDDY (RPH, PHD)
Entity type:Individual
Prefix:
First Name:RAMAMOHANA
Middle Name:REDDY
Last Name:JONNALA
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16286 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5201
Mailing Address - Country:US
Mailing Address - Phone:954-441-3149
Mailing Address - Fax:
Practice Address - Street 1:2700 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1335
Practice Address - Country:US
Practice Address - Phone:305-644-1994
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist