Basic Information
| Provider Information | |||||||||
| NPI: | 1467933655 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAMIDI | ||||||||
| FirstName: | MANOGNA | ||||||||
| MiddleName: | CHOUDARY | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1343 DIAMOND LOOP | ||||||||
| Address2: | |||||||||
| City: | WEST RICHLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993537841 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4820 N ROAD 68 | ||||||||
| Address2: | |||||||||
| City: | PASCO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993019009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095437947 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2018 | ||||||||
| LastUpdateDate: | 08/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PH60736800 | WA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.