Provider Demographics
NPI:1922109834
Name:NAGABHYIRU, SRINIVASU
Entity Type:Individual
Prefix:MR
First Name:SRINIVASU
Middle Name:
Last Name:NAGABHYIRU
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 1:8433 SOUTHSIDE BLVD
Mailing Address - Street 2:APT # 1307
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8476
Mailing Address - Country:US
Mailing Address - Phone:203-228-2118
Mailing Address - Fax:
Practice Address - Street 1:7941 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-783-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 41074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist