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General NPI Number Information
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NPI Number | 1104100817
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Entity Type | Individual
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Provider Name | PRAVEENA MALLIKA KANTETI
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Gender | Female
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Dates
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Enumeration Date | 09/30/2011
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 20 S MORTON ST
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City | FRANKLIN
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State | IN
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Zip | 46131-2102
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Country | US
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Telephone | 317-736-8089
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Fax |
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Provider Business Mailing Address
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Address Line | 6041 PRAIRIE STREAM WAY
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City | COLUMBUS
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State | IN
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Zip | 47203-9050
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Country | US
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Telephone | 248-844-9305
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26023020A
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License Number State | IN
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