Provider Demographics
NPI:1770972580
Name:NADIMPALLI, SRIDHAR
Entity type:Individual
Prefix:
First Name:SRIDHAR
Middle Name:
Last Name:NADIMPALLI
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 1:2815 DIRECTORS ROW
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5520
Mailing Address - Country:US
Mailing Address - Phone:407-270-6722
Mailing Address - Fax:407-270-6723
Practice Address - Street 1:2815 DIRECTORS ROW
Practice Address - Street 2:SUITE 700
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5520
Practice Address - Country:US
Practice Address - Phone:407-270-6722
Practice Address - Fax:407-270-6723
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist