Provider Demographics
NPI:1649868506
Name:SUTAPALLI, NARASA L
Entity type:Individual
Prefix:
First Name:NARASA
Middle Name:L
Last Name:SUTAPALLI
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 1:111 HOBBS HOLE LN
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-5081
Mailing Address - Country:US
Mailing Address - Phone:732-841-1289
Mailing Address - Fax:804-443-6846
Practice Address - Street 1:517 CHURCH LN
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-2227
Practice Address - Country:US
Practice Address - Phone:804-443-3461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist