Provider Demographics
NPI:1962734749
Name:KALIKI, PREETHAM REDDY
Entity type:Individual
Prefix:
First Name:PREETHAM
Middle Name:REDDY
Last Name:KALIKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2801
Mailing Address - Country:US
Mailing Address - Phone:125-358-2223
Mailing Address - Fax:125-358-2065
Practice Address - Street 1:9505 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2801
Practice Address - Country:US
Practice Address - Phone:125-358-2223
Practice Address - Fax:125-358-2065
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA69709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist