Provider Demographics
NPI:1205436722
Name:JAGARLAMUDI, CHOUDARY L
Entity type:Individual
Prefix:
First Name:CHOUDARY
Middle Name:L
Last Name:JAGARLAMUDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-5203
Mailing Address - Country:US
Mailing Address - Phone:405-410-9493
Mailing Address - Fax:
Practice Address - Street 1:13100 JOSEY LN
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-6351
Practice Address - Country:US
Practice Address - Phone:972-656-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist