Provider Demographics
NPI:1528111507
Name:BOKKA, NARENDAR REDDY
Entity type:Individual
Prefix:MR
First Name:NARENDAR
Middle Name:REDDY
Last Name:BOKKA
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 1:3 ROBIN CT
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4805
Mailing Address - Country:US
Mailing Address - Phone:516-938-5616
Mailing Address - Fax:
Practice Address - Street 1:739 NEW LOTS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-7305
Practice Address - Country:US
Practice Address - Phone:718-649-9535
Practice Address - Fax:718-649-3456
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02081276Medicaid