Provider Demographics
NPI:1245648039
Name:PULLELA, MADHUMATHI (RPH)
Entity type:Individual
Prefix:MS
First Name:MADHUMATHI
Middle Name:
Last Name:PULLELA
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 1:20052 HERITAGE POINT DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3343
Mailing Address - Country:US
Mailing Address - Phone:813-435-3463
Mailing Address - Fax:
Practice Address - Street 1:20052 HERITAGE POINT DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3343
Practice Address - Country:US
Practice Address - Phone:813-435-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist