Provider Demographics
NPI:1417507708
Name:ILANGOVAN, ULAGAPPAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ULAGAPPAN
Middle Name:
Last Name:ILANGOVAN
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 1:104 S EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4930
Mailing Address - Country:US
Mailing Address - Phone:304-923-4867
Mailing Address - Fax:
Practice Address - Street 1:104 S EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4930
Practice Address - Country:US
Practice Address - Phone:304-923-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206369183500000X
WVRP0006632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist