Healthcare Provider Details

I. General information

NPI: 1295641256
Provider Name (Legal Business Name): SREENIDHI S MADABHUSHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

V. Phone/Fax

Practice location:
  • Phone: 510-648-1886
  • Fax:
Mailing address:
  • Phone: 510-648-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03443769
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: