Provider Demographics
NPI:1255743324
Name:DODDAPANENI, SRI SIVA PRASAD (RPH)
Entity type:Individual
Prefix:MR
First Name:SRI SIVA PRASAD
Middle Name:
Last Name:DODDAPANENI
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 1:570 PAMLICO PLZ
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3337
Mailing Address - Country:US
Mailing Address - Phone:252-975-2006
Mailing Address - Fax:252-975-5189
Practice Address - Street 1:570 PAMLICO PLZ
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3337
Practice Address - Country:US
Practice Address - Phone:252-975-2006
Practice Address - Fax:252-975-5189
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist