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General NPI Number Information
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NPI Number | 1609123280
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Entity Type | Individual
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Provider Name | SRINIVASA KUMAR NANDYALA RPH
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Gender | Male
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 114 KILMAYNE DR
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City | CARY
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State | NC
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Zip | 27511-4465
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Country | US
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Telephone | 919-678-5027
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Fax | 919-678-5037
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Provider Business Mailing Address
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Address Line | 114 KILMAYNE DR
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City | CARY
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State | NC
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Zip | 27511-4465
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Country | US
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Telephone | 919-678-5027
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Fax | 919-678-5037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22662
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License Number State | NC
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