Provider Demographics
NPI:1902446354
Name:GARDIMALLA, HARI
Entity Type:Individual
Prefix:
First Name:HARI
Middle Name:
Last Name:GARDIMALLA
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 1:358 LANDA ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-5452
Mailing Address - Country:US
Mailing Address - Phone:830-730-5449
Mailing Address - Fax:830-455-4857
Practice Address - Street 1:358 LANDA ST STE 400
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5452
Practice Address - Country:US
Practice Address - Phone:830-730-5449
Practice Address - Fax:830-455-4857
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist