Healthcare Provider Details

I. General information

NPI: 1043466527
Provider Name (Legal Business Name): SATHEESH S GOTTIPATI R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHESTERBROOK BLVD STE B11 RITEAID PHARMACY
CHESTERBROOK PA
19087-5645
US

IV. Provider business mailing address

421 E LANCASTER AVE APT.# C-2
WAYNE PA
19087-4228
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-4490
  • Fax:
Mailing address:
  • Phone: 267-283-1245
  • Fax: 267-283-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442018
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: