Provider Demographics
NPI:1285882282
Name:IPPAGUNTA, VAMSIDHAR (RPH)
Entity type:Individual
Prefix:
First Name:VAMSIDHAR
Middle Name:
Last Name:IPPAGUNTA
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 1:936 MOUNTAIN CREEK RD
Mailing Address - Street 2:APT M129
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1743
Mailing Address - Country:US
Mailing Address - Phone:423-870-3837
Mailing Address - Fax:
Practice Address - Street 1:2010 MCCALLIE AVE
Practice Address - Street 2:APT M129
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3139
Practice Address - Country:US
Practice Address - Phone:423-870-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist