Healthcare Provider Details

I. General information

NPI: 1447615240
Provider Name (Legal Business Name): SUDHA S MOKKAPATI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GERMANTOWN AVE
PHILADELPHIA PA
19144-2033
US

IV. Provider business mailing address

4720 YORKSHIRE DR
MACUNGIE PA
18062-8256
US

V. Phone/Fax

Practice location:
  • Phone: 215-713-2695
  • Fax:
Mailing address:
  • Phone: 601-504-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450012
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: