Provider Demographics
NPI:1508207093
Name:PATCHALA, DEVENDRA KUMAR
Entity Type:Individual
Prefix:
First Name:DEVENDRA
Middle Name:KUMAR
Last Name:PATCHALA
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 1:2743 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7525
Mailing Address - Country:US
Mailing Address - Phone:214-919-2090
Mailing Address - Fax:214-919-2091
Practice Address - Street 1:2743 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7525
Practice Address - Country:US
Practice Address - Phone:214-919-2090
Practice Address - Fax:214-919-2091
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50052183500000X
ARPD12250183500000X
AZS019713183500000X
LAPST.020136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist