Healthcare Provider Details

I. General information

NPI: 1699523449
Provider Name (Legal Business Name): AMANI VEMULAPALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1691 GALISTEO ST STE A
SANTA FE NM
87505-4781
US

IV. Provider business mailing address

1691 GALISTEO ST STE A
SANTA FE NM
87505-4781
US

V. Phone/Fax

Practice location:
  • Phone: 505-772-9340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00010093
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: