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General NPI Number Information
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NPI Number | 1467053702
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Entity Type | Individual
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Provider Name | BALA BHASKAR YELLA RPH
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Gender | Male
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 1701 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19111-3802
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Country | US
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Telephone | 215-728-6300
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Fax | 215-728-6302
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Provider Business Mailing Address
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Address Line | 115 MEADOWBROOK DR
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-6838
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Country | US
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Telephone | 601-307-8957
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Fax | 215-728-6302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP455109
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License Number State | PA
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