Healthcare Provider Details

I. General information

NPI: 1073450128
Provider Name (Legal Business Name): VENKATA PIDAPARTHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 BROAD ST
CHATTANOOGA TN
37409-1027
US

IV. Provider business mailing address

668 SLIDING HOME RUN
CHATTANOOGA TN
37421-8006
US

V. Phone/Fax

Practice location:
  • Phone: 423-634-7797
  • Fax:
Mailing address:
  • Phone: 423-634-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49595
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: