Provider Demographics
NPI:1144689985
Name:CHANDALURI, AMAR KUMAR (RPH)
Entity type:Individual
Prefix:
First Name:AMAR
Middle Name:KUMAR
Last Name:CHANDALURI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 SANTENAY LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8176
Mailing Address - Country:US
Mailing Address - Phone:410-926-0698
Mailing Address - Fax:
Practice Address - Street 1:5055 SUN VALLEY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-8293
Practice Address - Country:US
Practice Address - Phone:775-374-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17948183500000X
NC21492183500000X
MAPH233737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist