Provider Demographics
NPI:1144513474
Name:KUNDRAPU, KANAKADURGA
Entity type:Individual
Prefix:MS
First Name:KANAKADURGA
Middle Name:
Last Name:KUNDRAPU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10818 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-3741
Mailing Address - Country:US
Mailing Address - Phone:757-596-7646
Mailing Address - Fax:757-596-9469
Practice Address - Street 1:10818 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3741
Practice Address - Country:US
Practice Address - Phone:757-596-7646
Practice Address - Fax:757-596-9469
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist