Individual ProviderSrinivasa Rao EdavalapatiPharmacistPharmacy Service ProvidersPractice Address4329 Broadway, Broadway Pharmacy, New York, NY 10033-2408(212) 740-8500PECOS EnrollmentBased on the most recent information from CMS, provider Srinivasa Rao Edavalapati does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 10 days ago.Profile DetailsProvider ID1356665731Provider TypeIndividualFull NameEdavalapati, Srinivasa RaoTitleMr.CredentialM.PHARMGenderMaleSole ProprietorNoEnumeration Date3/15/2010Last Updated3/15/2010Contact InformationPractice LocationPractice Address4329 Broadway, Broadway Pharmacy, New York, NY 10033-2408Phone(212) 740-8500Fax(212) 740-9400Mailing LocationMailing Address4329 Broadway, Broadway Pharmacy, New York, NY 10033-2408Phone(212) 740-8500Fax(212) 740-9400Provider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense050398New YorkCode183500000XDescriptionPharmacistPharmacy Service ProvidersLicense28RI02773400New Jersey