Provider Demographics
NPI:1407146855
Name:PINNOJU, SHIVAKUMAR (RPH, MBA)
Entity Type:Individual
Prefix:
First Name:SHIVAKUMAR
Middle Name:
Last Name:PINNOJU
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 EASTERN BLVD N
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5843
Mailing Address - Country:US
Mailing Address - Phone:301-693-2902
Mailing Address - Fax:240-513-6319
Practice Address - Street 1:186 EASTERN BLVD N
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5843
Practice Address - Country:US
Practice Address - Phone:301-693-2902
Practice Address - Fax:240-513-6319
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist