Provider Demographics
NPI:1053632547
Name:VENKATESWARAN, NALINI (NALINI VENKATESWARAN)
Entity Type:Individual
Prefix:
First Name:NALINI
Middle Name:
Last Name:VENKATESWARAN
Suffix:
Gender:F
Credentials:NALINI VENKATESWARAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 THOMAS SPEAKMAN DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1367
Mailing Address - Country:US
Mailing Address - Phone:484-840-1265
Mailing Address - Fax:484-840-1265
Practice Address - Street 1:7564-7570 HAVERFORD AVENUE
Practice Address - Street 2:RITE AID PHARMACY,
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151
Practice Address - Country:US
Practice Address - Phone:215-878-4636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045291L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist