Provider Demographics
NPI:1780984286
Name:KALIDINDI, LAHARI (RPH)
Entity type:Individual
Prefix:
First Name:LAHARI
Middle Name:
Last Name:KALIDINDI
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 1:306 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6342
Mailing Address - Country:US
Mailing Address - Phone:908-812-0706
Mailing Address - Fax:
Practice Address - Street 1:970 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1612
Practice Address - Country:US
Practice Address - Phone:631-363-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-30
Last Update Date:2010-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist