Provider Demographics
NPI:1477560183
Name:KUNAPARAJU, NAVEEN KUMAR
Entity Type:Individual
Prefix:
First Name:NAVEEN
Middle Name:KUMAR
Last Name:KUNAPARAJU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5229 JEFFERSON DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2605
Mailing Address - Country:US
Mailing Address - Phone:540-710-0034
Mailing Address - Fax:
Practice Address - Street 1:5229 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2605
Practice Address - Country:US
Practice Address - Phone:540-710-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207805183500000X
MI5302036300183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1GE809629OtherRITEAID HEALTH SOLUTIONS