Provider Demographics
NPI:1104109974
Name:PALLI, HAREESH KUMAR REDDY (RPH)
Entity type:Individual
Prefix:
First Name:HAREESH KUMAR REDDY
Middle Name:
Last Name:PALLI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 BIG BEND RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7723
Mailing Address - Country:US
Mailing Address - Phone:636-438-5095
Mailing Address - Fax:
Practice Address - Street 1:659 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021-7723
Practice Address - Country:US
Practice Address - Phone:636-438-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007003344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist