Provider Demographics
NPI:1447635446
Name:POTHUMARTHI, POORNIMA (PHARM D)
Entity type:Individual
Prefix:
First Name:POORNIMA
Middle Name:
Last Name:POTHUMARTHI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18125 N US HIGHWAY 41 STE 107
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-4498
Mailing Address - Country:US
Mailing Address - Phone:813-333-0750
Mailing Address - Fax:
Practice Address - Street 1:18125 N US HIGHWAY 41 STE 107
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-4498
Practice Address - Country:US
Practice Address - Phone:813-333-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS511711835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric