MEDICARE: MR. SRINIVASA R KOLLI PHARMACIST

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	044238	NY

General Provider Information

NPI Number	:	1851385777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SRINIVASA R KOLLI PHARMACIST

Provider Business Mailing Address
First Line	:	23 SHADOW RIDGE RD
Second Line	:	STAMFORD
City	:	STAMFORD
State	:	CT
Zip	:	06905-1800
Country	:	US
Telephone Number	:	203-968-1444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1227 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-3500
Country	:	US
Telephone Number	:	718-293-8777
Fax Number	:	718-992-1211

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	02/18/2025

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