Provider Demographics
NPI:1144507468
Name:PATLOLLA, SRILATHA (RPH)
Entity type:Individual
Prefix:
First Name:SRILATHA
Middle Name:
Last Name:PATLOLLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5243 SW 158TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4990
Mailing Address - Country:US
Mailing Address - Phone:305-231-9139
Mailing Address - Fax:
Practice Address - Street 1:4895 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4006
Practice Address - Country:US
Practice Address - Phone:305-231-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist