Healthcare Provider Details

I. General information

NPI: 1255639845
Provider Name (Legal Business Name): NAGAKISHORE BABU EDUPUGANTI R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FAYETTEVILLE RD
RALEIGH NC
27603-3614
US

IV. Provider business mailing address

609 IVYSHAW RD
CARY NC
27519-1537
US

V. Phone/Fax

Practice location:
  • Phone: 919-772-2640
  • Fax: 919-772-2913
Mailing address:
  • Phone: 919-772-2640
  • Fax: 919-772-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18690
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: