Provider Demographics
NPI:1124303615
Name:MARREDDI, SIVA KUMAR (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SIVA
Middle Name:KUMAR
Last Name:MARREDDI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11079 S MILITARY TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-7218
Mailing Address - Country:US
Mailing Address - Phone:561-736-2998
Mailing Address - Fax:
Practice Address - Street 1:11079 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-7218
Practice Address - Country:US
Practice Address - Phone:561-736-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist