Provider Demographics
NPI:1679893671
Name:CHEBROLU, TRIVIKRAM
Entity Type:Individual
Prefix:MR
First Name:TRIVIKRAM
Middle Name:
Last Name:CHEBROLU
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 1:4926 SW 45TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9758
Mailing Address - Country:US
Mailing Address - Phone:352-861-9343
Mailing Address - Fax:352-622-3938
Practice Address - Street 1:807 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6709
Practice Address - Country:US
Practice Address - Phone:352-861-9343
Practice Address - Fax:352-622-3938
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist