Healthcare Provider Details

I. General information

NPI: 1437437829
Provider Name (Legal Business Name): VENKATA M KOTHAPALLI RPH, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 BIRDWOOD CT
CARY NC
27519-9719
US

IV. Provider business mailing address

313 BIRDWOOD CT
CARY NC
27519-9719
US

V. Phone/Fax

Practice location:
  • Phone: 919-219-3199
  • Fax:
Mailing address:
  • Phone: 919-219-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10494
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: