Healthcare Provider Details

I. General information

NPI: 1194165779
Provider Name (Legal Business Name): MR. VENKATA RAO AKKINENI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VENKAT AKKINENI

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 RICHFIED ROAD
FLINT MI
48507
US

IV. Provider business mailing address

6123 QUARTZ CT
GRAND BLANC MI
48439-7832
US

V. Phone/Fax

Practice location:
  • Phone: 810-736-9913
  • Fax: 810-736-9407
Mailing address:
  • Phone: 810-845-5494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT 0011007
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP446425
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS55032
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035888
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: