Healthcare Provider Details

I. General information

NPI: 1578862850
Provider Name (Legal Business Name): VINUTHA KOTHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7228 HULL STREET RD
RICHMOND VA
23235-5804
US

IV. Provider business mailing address

7228 HULL STREET RD
RICHMOND VA
23235-5804
US

V. Phone/Fax

Practice location:
  • Phone: 804-276-5100
  • Fax:
Mailing address:
  • Phone: 804-276-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202209628
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3739
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: