MEDICARE: MR. JAYAPAL REDDY NARRA M.PHARM.

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	PH 60021390	WA

General Provider Information

NPI Number	:	1689995326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAYAPAL REDDY NARRA M.PHARM.

Provider Business Mailing Address
First Line	:	20285 111TH WAY SE
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98031-5565
Country	:	US
Telephone Number	:	253-981-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4416
Country	:	US
Telephone Number	:	253-564-2255
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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