Healthcare Provider Details

I. General information

NPI: 1427347798
Provider Name (Legal Business Name): MRS. SULOCHANA JUNNOTULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 KIRKWOOD HWY
NEWARK DE
19711-5718
US

IV. Provider business mailing address

713 OBSERVATORY DR
BEAR DE
19701-6835
US

V. Phone/Fax

Practice location:
  • Phone: 302-453-1337
  • Fax:
Mailing address:
  • Phone: 302-753-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0003789
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: