Provider Demographics
NPI:1730462045
Name:CHALLA, SREENIVAS
Entity Type:Individual
Prefix:MR
First Name:SREENIVAS
Middle Name:
Last Name:CHALLA
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 1:3619 N HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1642
Mailing Address - Country:US
Mailing Address - Phone:863-402-5624
Mailing Address - Fax:863-402-5627
Practice Address - Street 1:3619 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1642
Practice Address - Country:US
Practice Address - Phone:863-402-5624
Practice Address - Fax:863-402-5627
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist