Provider Demographics
NPI:1467662668
Name:KOSARAJU, KRISHNA S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISHNA
Middle Name:S
Last Name:KOSARAJU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31331 ANNISTON DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6863
Mailing Address - Country:US
Mailing Address - Phone:813-746-5703
Mailing Address - Fax:
Practice Address - Street 1:1122 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUSHNELL
Practice Address - State:FL
Practice Address - Zip Code:33513-5045
Practice Address - Country:US
Practice Address - Phone:352-568-0669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist