Healthcare Provider Details

I. General information

NPI: 1295103257
Provider Name (Legal Business Name): NINA KOTTAKUZHIYIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 AMBERLEIGH DR
SILVER SPRING MD
20905-5992
US

IV. Provider business mailing address

259 AMBERLEIGH DR
SILVER SPRING MD
20905-5992
US

V. Phone/Fax

Practice location:
  • Phone: 240-535-6455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21187
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: