Provider Demographics
NPI:1609199439
Name:POLAVARAPU, VENUGOPALAKRISHNA (RPH)
Entity Type:Individual
Prefix:MR
First Name:VENUGOPALAKRISHNA
Middle Name:
Last Name:POLAVARAPU
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4552
Mailing Address - Country:US
Mailing Address - Phone:516-627-8847
Mailing Address - Fax:
Practice Address - Street 1:202 W OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4011
Practice Address - Country:US
Practice Address - Phone:516-433-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist