Provider Demographics
NPI:1366695538
Name:PHILKHANA, VENKATAPATHI
Entity type:Individual
Prefix:
First Name:VENKATAPATHI
Middle Name:
Last Name:PHILKHANA
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 1:300 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-3257
Mailing Address - Country:US
Mailing Address - Phone:315-471-4139
Mailing Address - Fax:315-471-4155
Practice Address - Street 1:300 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3257
Practice Address - Country:US
Practice Address - Phone:315-471-4139
Practice Address - Fax:315-471-4155
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist