Healthcare Provider Details

I. General information

NPI: 1891002192
Provider Name (Legal Business Name): SRINIVAS VELESETTY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 JEFFERSON HTS D 102
CATSKILL NY
12414-1237
US

IV. Provider business mailing address

159 JEFFERSON HTS D 102
CATSKILL NY
12414-1237
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-1715
  • Fax: 518-943-4816
Mailing address:
  • Phone: 518-943-1715
  • Fax: 518-943-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007174
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03290400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: