Provider Demographics
NPI:1285906834
Name:KOLLI, VAMSI K
Entity type:Individual
Prefix:MR
First Name:VAMSI
Middle Name:K
Last Name:KOLLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EMERSON AVE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-6937
Mailing Address - Country:US
Mailing Address - Phone:202-631-9584
Mailing Address - Fax:
Practice Address - Street 1:37 EMERSON AVE
Practice Address - Street 2:FLOOR 2
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-6937
Practice Address - Country:US
Practice Address - Phone:202-631-9584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03425200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist