Provider Demographics
NPI:1760653711
Name:MADDUKURI, VENU G (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:VENU
Middle Name:G
Last Name:MADDUKURI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2558 GRAND CONCOURSE
Mailing Address - Street 2:STREET LEVEL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4903
Mailing Address - Country:US
Mailing Address - Phone:718-364-7070
Mailing Address - Fax:718-364-3033
Practice Address - Street 1:2558 GRAND CONCOURSE
Practice Address - Street 2:STREET LEVEL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4903
Practice Address - Country:US
Practice Address - Phone:718-364-7070
Practice Address - Fax:718-364-3033
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031282183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric