Provider Demographics
NPI:1699440644
Name:ANUMASU, SRILATHA (RPH)
Entity type:Individual
Prefix:
First Name:SRILATHA
Middle Name:
Last Name:ANUMASU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 CHANTERELLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-8000
Mailing Address - Country:US
Mailing Address - Phone:732-567-2138
Mailing Address - Fax:
Practice Address - Street 1:116 BLACKFORD WAY
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-1876
Practice Address - Country:US
Practice Address - Phone:904-436-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist