Provider Demographics
NPI:1174528046
Name:SHANKAR, GOLLAPUDI SIVA (MS, PHARMD, PHC, BCP)
Entity type:Individual
Prefix:DR
First Name:GOLLAPUDI
Middle Name:SIVA
Last Name:SHANKAR
Suffix:
Gender:M
Credentials:MS, PHARMD, PHC, BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 N BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-3803
Mailing Address - Country:US
Mailing Address - Phone:956-523-7850
Mailing Address - Fax:956-523-7851
Practice Address - Street 1:4602 N BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3803
Practice Address - Country:US
Practice Address - Phone:956-523-7850
Practice Address - Fax:956-523-7851
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405951835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric