Provider Demographics
NPI:1902316367
Name:JANAPAREDDY, PADMAJA
Entity Type:Individual
Prefix:
First Name:PADMAJA
Middle Name:
Last Name:JANAPAREDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12344 NW BARNES RD APT 437
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6063
Mailing Address - Country:US
Mailing Address - Phone:407-760-1202
Mailing Address - Fax:
Practice Address - Street 1:1010 SW JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-3425
Practice Address - Country:US
Practice Address - Phone:503-205-1849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS-40786183500000X
ORRPH-0016163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist