Provider Demographics
NPI:1194165779
Name:AKKINENI, VENKATA RAO
Entity type:Individual
Prefix:MR
First Name:VENKATA RAO
Middle Name:
Last Name:AKKINENI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VENKAT
Other - Middle Name:
Other - Last Name:AKKINENI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29004 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7210
Mailing Address - Country:US
Mailing Address - Phone:810-845-5494
Mailing Address - Fax:
Practice Address - Street 1:29004 GREGORY ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7210
Practice Address - Country:US
Practice Address - Phone:810-845-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035888183500000X
CTPCT 0011007183500000X
PARP446425183500000X
NY056781183500000X
FLPS55032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist