Healthcare Provider Details

I. General information

NPI: 1114292505
Provider Name (Legal Business Name): VENU PEDDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 LIMITED LN NW
OLYMPIA WA
98502-2613
US

IV. Provider business mailing address

3007 LIMITED LN NW
OLYMPIA WA
98502-2613
US

V. Phone/Fax

Practice location:
  • Phone: 360-350-1718
  • Fax:
Mailing address:
  • Phone: 360-504-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60105280
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: