Provider Demographics
NPI:1174804660
Name:BELLAMKONDA, VENKATA (BPHARMACY, MS)
Entity type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:
Last Name:BELLAMKONDA
Suffix:
Gender:M
Credentials:BPHARMACY, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-4127
Mailing Address - Country:US
Mailing Address - Phone:904-529-9156
Mailing Address - Fax:904-529-9108
Practice Address - Street 1:103 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-4127
Practice Address - Country:US
Practice Address - Phone:904-529-9156
Practice Address - Fax:904-529-9108
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist