Provider Demographics
NPI:1902093792
Name:GUMMADI, SRICHARAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SRICHARAN
Middle Name:
Last Name:GUMMADI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3810
Mailing Address - Country:US
Mailing Address - Phone:718-567-0019
Mailing Address - Fax:718-567-0029
Practice Address - Street 1:5816 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3810
Practice Address - Country:US
Practice Address - Phone:718-567-0019
Practice Address - Fax:718-567-0029
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16913183500000X
NH3374183500000X
NJ28RI03062700183500000X
NY051840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist