MEDICARE: PRATIKSHA KUPPUSAMY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	44250	TX

General Provider Information

NPI Number	:	1265760011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATIKSHA KUPPUSAMY RPH

Provider Business Mailing Address
First Line	:	1508 MILAGRO DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78733-5754
Country	:	US
Telephone Number	:	914-882-3706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 RANCH ROAD 620 S
Second Line	:
City	:	LAKEWAY
State	:	TX
Zip	:	78738-5603
Country	:	US
Telephone Number	:	512-236-7887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	12/04/2009

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Directions to “ PRATIKSHA KUPPUSAMY RPH” Practice Location

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