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General NPI Number Information
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NPI Number | 1922109834
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Entity Type | Individual
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Provider Name | MR. SRINIVASU NAGABHYIRU
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7941 NORMANDY BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32210
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Country | US
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Telephone | 904-783-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 8433 SOUTHSIDE BLVD APT # 1307
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8476
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Country | US
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Telephone | 203-228-2118
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Fax |
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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 | PS 41074
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License Number State | FL
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