Healthcare Provider Details

I. General information

NPI: 1154258044
Provider Name (Legal Business Name): SIRISHA KOTHAPALLI PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 STATE ROUTE 741
MASON OH
45040
US

IV. Provider business mailing address

4578 MEADOWBROOK LN
MASON OH
45040-4501
US

V. Phone/Fax

Practice location:
  • Phone: 513-398-8820
  • Fax:
Mailing address:
  • Phone: 609-638-9839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03327154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: