Healthcare Provider Details

I. General information

NPI: 1477560183
Provider Name (Legal Business Name): NAVEEN KUMAR KUNAPARAJU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5229 JEFFERSON DAVIS HWY
FREDERICKSBURG VA
22408-2605
US

IV. Provider business mailing address

5229 JEFFERSON DAVIS HWY
FREDERICKSBURG VA
22408-2605
US

V. Phone/Fax

Practice location:
  • Phone: 540-710-0034
  • Fax:
Mailing address:
  • Phone: 540-710-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207805
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number5302036300
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: