Provider Demographics
NPI:1770877565
Name:KONERU, MRIDULA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MRIDULA
Middle Name:
Last Name:KONERU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7549 W MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-1358
Mailing Address - Country:US
Mailing Address - Phone:317-340-7188
Mailing Address - Fax:317-248-5518
Practice Address - Street 1:7549 W MORRIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-1358
Practice Address - Country:US
Practice Address - Phone:317-340-7188
Practice Address - Fax:317-248-5518
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022543A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist