Provider Demographics
NPI:1457633927
Name:FERNANDO, KAKULAWALAGE UPEKA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:KAKULAWALAGE
Middle Name:UPEKA
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3056
Mailing Address - Country:US
Mailing Address - Phone:732-701-2586
Mailing Address - Fax:732-892-4149
Practice Address - Street 1:1513 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-3056
Practice Address - Country:US
Practice Address - Phone:732-701-2586
Practice Address - Fax:732-892-4149
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03305100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist