MEDICARE: DR. YASHWANTH REDDY KOMERELLI PHARM.D., MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	1-120625	KS

General Provider Information

NPI Number	:	1225717978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YASHWANTH REDDY KOMERELLI PHARM.D., MPH

Provider Business Mailing Address
First Line	:	1345 VAN FLEET LN
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-6313
Country	:	US
Telephone Number	:	314-789-0334
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 10TH ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-3551
Country	:	US
Telephone Number	:	620-792-4467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/11/2023

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