Provider Demographics
NPI:1487883336
Name:NADIMPALLI, OMPHANIDHAR
Entity type:Individual
Prefix:MR
First Name:OMPHANIDHAR
Middle Name:
Last Name:NADIMPALLI
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 1:492 ADAM LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-2478
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:142 WALLACE AVE STE 106
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2643
Practice Address - Country:US
Practice Address - Phone:484-593-4321
Practice Address - Fax:484-593-4327
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16026183500000X
PARP438324183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist