MEDICARE: MR. VENKATESWARA P BOLLINENI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS0041897	FL

General Provider Information

NPI Number	:	1558570275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VENKATESWARA P BOLLINENI

Provider Business Mailing Address
First Line	:	6285 LIGHTNER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7613
Country	:	US
Telephone Number	:	407-690-0794
Fax Number	:	407-293-0222

Provider Business Practice Location Address
First Line	:	5739 EDGEWATER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-5258
Country	:	US
Telephone Number	:	407-293-6600
Fax Number	:	407-293-0222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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