Provider Demographics
NPI:1548544208
Name:NARLA, RAJ (RPH)
Entity type:Individual
Prefix:MR
First Name:RAJ
Middle Name:
Last Name:NARLA
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 1:2400 GEORGE WASHINGTON MEM HWY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3404
Mailing Address - Country:US
Mailing Address - Phone:757-867-7109
Mailing Address - Fax:757-867-8271
Practice Address - Street 1:2400 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3404
Practice Address - Country:US
Practice Address - Phone:757-867-7109
Practice Address - Fax:757-867-8271
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206384183500000X
NJ28RI03333000183500000X
PARP444390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist