Provider Demographics
NPI:1194057844
Name:ARAMALLA, PURNACHANDRA REDDI (R PH)
Entity type:Individual
Prefix:MR
First Name:PURNACHANDRA
Middle Name:REDDI
Last Name:ARAMALLA
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:39-11 104TH STREET
Mailing Address - Street 2:A FAIR DEAL PHARMACY, INC.
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2313
Mailing Address - Country:US
Mailing Address - Phone:718-478-3908
Mailing Address - Fax:718-478-3908
Practice Address - Street 1:39-11 104TH STREET
Practice Address - Street 2:A FAIR DEAL PHARMACY, INC.
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2313
Practice Address - Country:US
Practice Address - Phone:718-478-3908
Practice Address - Fax:718-478-3908
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01311595Medicaid
NY037727OtherNEW YORK STATE BOARD OF PHARMACY