Provider Demographics
NPI:1144692252
Name:SRIHARSHA BINGI, LAKSHMI
Entity type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:SRIHARSHA BINGI
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 1:55 HOWLAND ST
Mailing Address - Street 2:APT 1C
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2142
Mailing Address - Country:US
Mailing Address - Phone:978-918-1064
Mailing Address - Fax:
Practice Address - Street 1:US-95
Practice Address - Street 2:SAFEWAY
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415
Practice Address - Country:US
Practice Address - Phone:775-945-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist