1962823955 NPI number — DR. VAMSEEN JETTI PA

Table of content: DR. SHEILA ANN SALAMUNOVICH PHARM.D. (NPI 1033194485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962823955 NPI number — DR. VAMSEEN JETTI PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. VAMSEEN JETTI PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962823955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3610 GILLESPIE ST
Provider Second Line Business Mailing Address:
#3
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75219-4839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-505-3884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 W PARKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-8185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-668-7460
Provider Business Practice Location Address Fax Number:
972-668-7467
Provider Enumeration Date:
12/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JETTI
Authorized Official First Name:
VAMSEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
202-505-3884

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  P6981 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P6981 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".