Provider Demographics
NPI:1851385777
Name:KOLLI, SRINIVASA R (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:SRINIVASA
Middle Name:R
Last Name:KOLLI
Suffix:
Gender:
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SHADOW RIDGE RD
Mailing Address - Street 2:STAMFORD
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1800
Mailing Address - Country:US
Mailing Address - Phone:203-968-1444
Mailing Address - Fax:
Practice Address - Street 1:1227 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3500
Practice Address - Country:US
Practice Address - Phone:718-293-8777
Practice Address - Fax:718-992-1211
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist