Provider Demographics
NPI:1871875641
Name:KORIMILLI, USHASRI
Entity type:Individual
Prefix:
First Name:USHASRI
Middle Name:
Last Name:KORIMILLI
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 1:5168 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-3854
Mailing Address - Country:US
Mailing Address - Phone:510-745-8140
Mailing Address - Fax:
Practice Address - Street 1:5168 AMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-3854
Practice Address - Country:US
Practice Address - Phone:510-745-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA51942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist