Provider Demographics
NPI:1003105115
Name:KODIMELA, SWAPNA (RPH)
Entity Type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:KODIMELA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 GREAT FALLS PLZ
Mailing Address - Street 2:20800 GREAT FALLS PLAZA
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-2464
Mailing Address - Country:US
Mailing Address - Phone:703-421-4020
Mailing Address - Fax:
Practice Address - Street 1:20800 GREAT FALLS PLZ
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-2464
Practice Address - Country:US
Practice Address - Phone:703-421-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202208230OtherRPH WITH COMMONWEALTH OF VIRGINIA