Provider Demographics
NPI:1063669950
Name:KAVURI, SRINIVAS RAO (BS)
Entity type:Individual
Prefix:MR
First Name:SRINIVAS
Middle Name:RAO
Last Name:KAVURI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8722 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3412
Mailing Address - Country:US
Mailing Address - Phone:718-272-8450
Mailing Address - Fax:718-272-4279
Practice Address - Street 1:8722 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3412
Practice Address - Country:US
Practice Address - Phone:718-272-8450
Practice Address - Fax:718-272-4279
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190307Medicaid
NY02190307Medicaid