MEDICARE: VENKATESWARLU MARELLA R.PH

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	33600	NY

General Provider Information

NPI Number	:	1821311200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENKATESWARLU MARELLA R.PH

Provider Business Mailing Address
First Line	:	2718 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-3706
Country	:	US
Telephone Number	:	212-283-6228
Fax Number	:	212-281-2635

Provider Business Practice Location Address
First Line	:	2718 8TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-3706
Country	:	US
Telephone Number	:	212-283-6228
Fax Number	:	212-281-2635

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

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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