Provider Demographics
NPI:1932476835
Name:KARAMSETTY, MALLIK (RPH)
Entity type:Individual
Prefix:DR
First Name:MALLIK
Middle Name:
Last Name:KARAMSETTY
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 1:10913 VIRGINIA FOREST CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6503
Mailing Address - Country:US
Mailing Address - Phone:804-747-6866
Mailing Address - Fax:
Practice Address - Street 1:11300 NUCKOLS RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5503
Practice Address - Country:US
Practice Address - Phone:804-270-4683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist