Provider Demographics
NPI:1790069508
Name:SONTINENI, PRABHAKARA RAO
Entity Type:Individual
Prefix:MR
First Name:PRABHAKARA
Middle Name:RAO
Last Name:SONTINENI
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 1:5950 SW 74TH ST
Mailing Address - Street 2:APT#210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5158
Mailing Address - Country:US
Mailing Address - Phone:305-766-6171
Mailing Address - Fax:
Practice Address - Street 1:1695 NW 20TH STREET
Practice Address - Street 2:WALGREENS CO
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142
Practice Address - Country:US
Practice Address - Phone:305-591-9243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist