Provider Demographics
NPI:1356747919
Name:MALADI, SREEDHAR (RPH)
Entity type:Individual
Prefix:
First Name:SREEDHAR
Middle Name:
Last Name:MALADI
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 1:5966 MONCRIEF RD STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-2538
Mailing Address - Country:US
Mailing Address - Phone:904-379-3195
Mailing Address - Fax:904-551-0972
Practice Address - Street 1:5966 MONCRIEF RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-2538
Practice Address - Country:US
Practice Address - Phone:904-379-3195
Practice Address - Fax:904-551-0972
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist