Provider Demographics
NPI:1982046918
Name:PUDIPEDDI, LAKSHMANA MADHUSUDAN (RPH)
Entity type:Individual
Prefix:MR
First Name:LAKSHMANA
Middle Name:MADHUSUDAN
Last Name:PUDIPEDDI
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 1:978 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-1913
Mailing Address - Country:US
Mailing Address - Phone:203-367-9000
Mailing Address - Fax:203-367-9004
Practice Address - Street 1:978 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-1913
Practice Address - Country:US
Practice Address - Phone:203-367-9000
Practice Address - Fax:203-367-9004
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT10456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist