Provider Demographics
NPI:1619312543
Name:PAVULURI, VENKATESWARA RAO (PHD; RPH)
Entity Type:Individual
Prefix:DR
First Name:VENKATESWARA
Middle Name:RAO
Last Name:PAVULURI
Suffix:
Gender:M
Credentials:PHD; RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769-1158
Mailing Address - Country:US
Mailing Address - Phone:301-859-4377
Mailing Address - Fax:
Practice Address - Street 1:5601 FISHERS LANE
Practice Address - Street 2:9F48
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:301-896-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19595183500000X
VA0202211228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist