Provider Demographics
NPI:1891002192
Name:VELESETTY, SRINIVAS (RPH)
Entity Type:Individual
Prefix:
First Name:SRINIVAS
Middle Name:
Last Name:VELESETTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 JEFFERSON HTS
Mailing Address - Street 2:D 102
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1237
Mailing Address - Country:US
Mailing Address - Phone:518-943-1715
Mailing Address - Fax:518-943-4816
Practice Address - Street 1:159 JEFFERSON HTS
Practice Address - Street 2:D 102
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1237
Practice Address - Country:US
Practice Address - Phone:518-943-1715
Practice Address - Fax:518-943-4816
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007174183500000X
NJ28RI03290400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03290400OtherNEW JERSEY BOP
NMRP00007174OtherNEWMEXICO BOARD OF PHARMACY