Provider Demographics
NPI:1174035489
Name:KANUGA, MALAV D
Entity Type:Individual
Prefix:MR
First Name:MALAV
Middle Name:D
Last Name:KANUGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 POTOMAC RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-3081
Mailing Address - Country:US
Mailing Address - Phone:732-668-2835
Mailing Address - Fax:
Practice Address - Street 1:10 S NEW PROSPECT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1645
Practice Address - Country:US
Practice Address - Phone:732-370-4777
Practice Address - Fax:732-370-4777
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03131900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist