Provider Demographics
NPI:1144638073
Name:BOMMU, SREENADHA REDDY (RPH)
Entity type:Individual
Prefix:MR
First Name:SREENADHA REDDY
Middle Name:
Last Name:BOMMU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 NC HIGHWAY 55 W
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-8526
Mailing Address - Country:US
Mailing Address - Phone:919-658-2608
Mailing Address - Fax:
Practice Address - Street 1:308 NC HIGHWAY 55 W
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-8526
Practice Address - Country:US
Practice Address - Phone:919-658-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist