Provider Demographics
NPI:1023388717
Name:SUPPIAH, KULENDRAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KULENDRAN
Middle Name:
Last Name:SUPPIAH
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 1:16102 BRECON PALMS PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-5123
Mailing Address - Country:US
Mailing Address - Phone:813-903-0494
Mailing Address - Fax:
Practice Address - Street 1:930 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8842
Practice Address - Country:US
Practice Address - Phone:813-684-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist