Provider Demographics
NPI:1346425972
Name:DONDAPATI, VENKATA RAJESH
Entity Type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:RAJESH
Last Name:DONDAPATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E 115TH ST
Mailing Address - Street 2:SECOND AVE PHARMACY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2130
Mailing Address - Country:US
Mailing Address - Phone:212-876-8300
Mailing Address - Fax:
Practice Address - Street 1:249 E 115TH ST
Practice Address - Street 2:SECOND AVE PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2130
Practice Address - Country:US
Practice Address - Phone:212-876-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist