MEDICARE: DR. BHAVANI REDDY THALAMARLA PHARMD

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	PS32395	FL

General Provider Information

NPI Number	:	1679842884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHAVANI REDDY THALAMARLA PHARMD

Provider Business Mailing Address
First Line	:	3001 SIMPSON RD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4680
Country	:	US
Telephone Number	:	407-409-2480
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 S ORANGE BLOSSOM TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32839-1704
Country	:	US
Telephone Number	:	407-851-6040
Fax Number	:

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

Provider Enumeration Date	:	12/16/2011
Last Update Date	:	12/17/2022

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