Provider Demographics
NPI:1487945622
Name:NEKKANTI, SIRISHA
Entity type:Individual
Prefix:
First Name:SIRISHA
Middle Name:
Last Name:NEKKANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 DOWNING GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-6455
Mailing Address - Country:US
Mailing Address - Phone:919-462-9581
Mailing Address - Fax:
Practice Address - Street 1:1505 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3314
Practice Address - Country:US
Practice Address - Phone:919-286-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist