Healthcare Provider Details

I. General information

NPI: 1669771770
Provider Name (Legal Business Name): SATISH YELAMANCHILI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date: 03/09/2018
Reactivation Date: 12/15/2022

III. Provider practice location address

5229 JEFFERSON DAVIS HWY
FREDERICKSBURG VA
22408-2605
US

IV. Provider business mailing address

5229 JEFFERSON DAVIS HWY
FREDERICKSBURG VA
22408-2605
US

V. Phone/Fax

Practice location:
  • Phone: 540-710-0034
  • Fax: 540-710-7931
Mailing address:
  • Phone: 540-710-0034
  • Fax: 540-710-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202208289
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: