Provider Demographics
NPI:1831646025
Name:PITTALA, GIRIDHAR
Entity type:Individual
Prefix:
First Name:GIRIDHAR
Middle Name:
Last Name:PITTALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 WEST ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2441
Mailing Address - Country:US
Mailing Address - Phone:603-357-2840
Mailing Address - Fax:603-358-6133
Practice Address - Street 1:268 WEST ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2441
Practice Address - Country:US
Practice Address - Phone:603-357-2840
Practice Address - Fax:603-358-6133
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist