=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326451204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRASANNA LAKSHMI BUTCHIREDDYGARI CLINICAL PHARMACIST
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2014
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | USAMEDDAC 2480 LLEWELLYN AVENUE
-----------------------------------------------------
City | FORT GEORGE G MEADE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-677-8395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | USAMEDDAC 2480 LLEWELLYN AVE
-----------------------------------------------------
City | FORT MEADE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-677-8395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 21334
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------