MEDICARE: MRS. KAKULAWALAGE UPEKA FERNANDO PHARM. D

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	28RI03305100	NJ

General Provider Information

NPI Number	:	1457633927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAKULAWALAGE UPEKA FERNANDO PHARM. D

Provider Business Mailing Address
First Line	:	1513 RICHMOND AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3056
Country	:	US
Telephone Number	:	732-701-2586
Fax Number	:	732-892-4149

Provider Business Practice Location Address
First Line	:	1513 RICHMOND AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-3056
Country	:	US
Telephone Number	:	732-701-2586
Fax Number	:	732-892-4149

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	09/12/2011

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