Provider Demographics
NPI:1336743236
Name:JOOLUKUNTLA, DEEPTHI
Entity Type:Individual
Prefix:
First Name:DEEPTHI
Middle Name:
Last Name:JOOLUKUNTLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAMDEN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-2003
Mailing Address - Country:US
Mailing Address - Phone:210-225-4561
Mailing Address - Fax:
Practice Address - Street 1:311 CAMDEN ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2003
Practice Address - Country:US
Practice Address - Phone:210-225-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist