Provider Demographics
NPI:1437437829
Name:KOTHAPALLI, VENKATA M (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:M
Last Name:KOTHAPALLI
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 BIRDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9719
Mailing Address - Country:US
Mailing Address - Phone:919-219-3199
Mailing Address - Fax:
Practice Address - Street 1:313 BIRDWOOD CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-9719
Practice Address - Country:US
Practice Address - Phone:919-219-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist