Provider Demographics
NPI:1730790395
Name:MUTHONDU, HARRIET N
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:N
Last Name:MUTHONDU
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 1:3140 TCHULAHOMA RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2722
Mailing Address - Country:US
Mailing Address - Phone:678-463-4995
Mailing Address - Fax:
Practice Address - Street 1:3140 TCHULAHOMA RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2722
Practice Address - Country:US
Practice Address - Phone:678-463-4995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-16
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist