Provider Demographics
NPI:1154549343
Name:CHEEDHELLA, VENKATA NAGA LAXMI (RPH)
Entity type:Individual
Prefix:MRS
First Name:VENKATA
Middle Name:NAGA LAXMI
Last Name:CHEEDHELLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 CLEARLAKE RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6384
Mailing Address - Country:US
Mailing Address - Phone:321-549-5005
Mailing Address - Fax:321-549-6226
Practice Address - Street 1:378 N BABCOCK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7344
Practice Address - Country:US
Practice Address - Phone:321-549-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist