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General NPI Number Information
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NPI Number | 1558570275
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Entity Type | Individual
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Provider Name | MR. VENKATESWARA P BOLLINENI
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5739 EDGEWATER DR
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City | ORLANDO
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State | FL
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Zip | 32810-5258
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Country | US
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Telephone | 407-293-6600
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Fax | 407-293-0222
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Provider Business Mailing Address
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Address Line | 6285 LIGHTNER DR
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City | ORLANDO
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State | FL
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Zip | 32829-7613
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Country | US
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Telephone | 407-690-0794
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Fax | 407-293-0222
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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 | PS0041897
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License Number State | FL
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