Provider Demographics
NPI:1679842884
Name:THALAMARLA, BHAVANI REDDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:REDDY
Last Name:THALAMARLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SIMPSON RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4680
Mailing Address - Country:US
Mailing Address - Phone:407-409-2480
Mailing Address - Fax:
Practice Address - Street 1:4502 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-1704
Practice Address - Country:US
Practice Address - Phone:407-851-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist