Provider Demographics
NPI:1336454735
Name:MADHIREDDY, SUJANA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SUJANA
Middle Name:
Last Name:MADHIREDDY
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 1:78 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1640
Mailing Address - Country:US
Mailing Address - Phone:908-782-2017
Mailing Address - Fax:908-782-1229
Practice Address - Street 1:78 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1640
Practice Address - Country:US
Practice Address - Phone:908-782-2017
Practice Address - Fax:908-782-1229
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3379183500000X
VT033.0003795183500000X
MD16995183500000X
NJ28RI03104300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist