Provider Demographics
NPI:1316541667
Name:IYENGAR, KALPANA SRINIVASAN
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:SRINIVASAN
Last Name:IYENGAR
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 1:2451 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9088
Mailing Address - Country:US
Mailing Address - Phone:972-347-9043
Mailing Address - Fax:972-347-9198
Practice Address - Street 1:2451 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-9088
Practice Address - Country:US
Practice Address - Phone:972-347-9043
Practice Address - Fax:972-347-9198
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist