Provider Demographics
NPI:1093458473
Name:VENKANNAGARI, SRIKANTH REDDY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:REDDY
Last Name:VENKANNAGARI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WILLIAM BLOW CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-7003
Mailing Address - Country:US
Mailing Address - Phone:847-902-0835
Mailing Address - Fax:
Practice Address - Street 1:2343 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8111
Practice Address - Country:US
Practice Address - Phone:718-561-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063981-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist