Individual
MR. BANGARRAJU PENUMETSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11901 JAMAICA AVE, RICHMOND HILL, NY 11418-2512
(718) 847-9850
Mailing address
11901 JAMAICA AVE, RICHMOND HILL, NY 11418-2512
(718) 847-9850
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
049201
NY
183500000X
Pharmacist
16662
MD
183500000X
Pharmacist
28RI03182500
NJ
183500000X
Pharmacist
5302035241
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02646817
—
NY
Enumeration date
08/29/2008
Last updated
08/29/2008
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