Healthcare Provider Details

I. General information

NPI: 1780960906
Provider Name (Legal Business Name): NAGESWARA RAO KOTTAPALLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12028 MAJESTIC BLVD
HUDSON FL
34667-2418
US

IV. Provider business mailing address

12028 MAJESTIC BLVD
HUDSON FL
34667-2418
US

V. Phone/Fax

Practice location:
  • Phone: 727-534-2533
  • Fax:
Mailing address:
  • Phone: 727-534-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: