Provider Demographics
NPI:1215531520
Name:KOLLI, RAJESWARI RAO
Entity type:Individual
Prefix:
First Name:RAJESWARI
Middle Name:RAO
Last Name:KOLLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAJI
Other - Middle Name:
Other - Last Name:KOLLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 FLOWER MOUND RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3503
Mailing Address - Country:US
Mailing Address - Phone:972-874-8421
Mailing Address - Fax:972-874-8467
Practice Address - Street 1:1100 FLOWER MOUND RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3503
Practice Address - Country:US
Practice Address - Phone:972-874-8421
Practice Address - Fax:972-874-8467
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist