Provider Demographics
NPI:1013369339
Name:PENDYALA, YADAGIRI R (RPH)
Entity Type:Individual
Prefix:MR
First Name:YADAGIRI
Middle Name:R
Last Name:PENDYALA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-1419
Mailing Address - Country:US
Mailing Address - Phone:856-514-2638
Mailing Address - Fax:856-514-2678
Practice Address - Street 1:182 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-1419
Practice Address - Country:US
Practice Address - Phone:856-514-2638
Practice Address - Fax:856-514-2678
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03332300183500000X
TX48322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist