Provider Demographics
NPI:1811872674
Name:KALLAM, SRILATHA (RPH)
Entity type:Individual
Prefix:
First Name:SRILATHA
Middle Name:
Last Name:KALLAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N KESWICK AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4840
Mailing Address - Country:US
Mailing Address - Phone:215-572-1118
Mailing Address - Fax:215-572-0555
Practice Address - Street 1:241 N KESWICK AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4840
Practice Address - Country:US
Practice Address - Phone:215-572-1118
Practice Address - Fax:215-572-0555
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-09
Last Update Date:2025-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist