Individual ProviderSuryanarayana MaddulaPharmacistPharmacy Service ProvidersPractice Address161 Smith St, Brooklyn, NY 11201-6337(718) 596-1688PECOS EnrollmentBased on the most recent information from CMS, provider Suryanarayana Maddula 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 4 days ago.Profile DetailsProvider ID1750604716Provider TypeIndividualFull NameMaddula, SuryanarayanaTitleMr.CredentialRPHGenderMaleSole ProprietorYesEnumeration Date3/4/2010Last Updated3/4/2010Contact InformationPractice LocationPractice Address161 Smith St, Brooklyn, NY 11201-6337Phone(718) 596-1688Fax(718) 237-6078Mailing LocationMailing Address161 Smith St, Brooklyn, NY 11201-6337Phone(718) 596-1688Fax(718) 237-6078Provider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicense32022New YorkProvider IdentifiersIDDescriptionIssuerID00755202DescriptionMedicaidIssuerUnlistedNew York