Provider Demographics
NPI:1417765215
Name:KOLLI, BHAVYA R
Entity type:Individual
Prefix:
First Name:BHAVYA
Middle Name:R
Last Name:KOLLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 E WELLS BRANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3679
Mailing Address - Country:US
Mailing Address - Phone:512-687-0552
Mailing Address - Fax:
Practice Address - Street 1:1509 E WELLS BRANCH PKWY
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3679
Practice Address - Country:US
Practice Address - Phone:512-687-0552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist