MEDICARE: NAGASURESH KAKUMANU

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	28RI02587000	NJ
2	183500000X	Pharmacist	051589	NY

General Provider Information

NPI Number	:	1376850305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGASURESH KAKUMANU

Provider Business Mailing Address
First Line	:	18 HAWK CT
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2275
Country	:	US
Telephone Number	:	732-690-9689
Fax Number	:	201-222-1901

Provider Business Practice Location Address
First Line	:	570 NEWARK AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2330
Country	:	US
Telephone Number	:	201-653-4093
Fax Number	:	201-222-1901

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

Provider Enumeration Date	:	09/13/2010
Last Update Date	:	09/13/2010

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Directions to “ NAGASURESH KAKUMANU ” Practice Location

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