Provider Demographics
NPI:1417247156
Name:KANDEPU, NARAYANA M (RPH)
Entity Type:Individual
Prefix:MR
First Name:NARAYANA
Middle Name:M
Last Name:KANDEPU
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 1:11067 PEACHCOVE CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6103
Mailing Address - Country:US
Mailing Address - Phone:404-370-0585
Mailing Address - Fax:404-370-0585
Practice Address - Street 1:2886 MEMORIAL DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-3317
Practice Address - Country:US
Practice Address - Phone:404-370-0585
Practice Address - Fax:404-370-0585
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist