Provider Demographics
NPI:1215117031
Name:SANNIDHI, SUBBARAO VENKATA (RPH)
Entity type:Individual
Prefix:MR
First Name:SUBBARAO
Middle Name:VENKATA
Last Name:SANNIDHI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3302
Mailing Address - Country:US
Mailing Address - Phone:732-668-4325
Mailing Address - Fax:718-729-3211
Practice Address - Street 1:4002 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3302
Practice Address - Country:US
Practice Address - Phone:732-668-4325
Practice Address - Fax:718-729-3211
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032017OtherLICENSE REGISTRATION NUMB