Provider Demographics
NPI:1508298506
Name:KURRA, ANUP (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANUP
Middle Name:
Last Name:KURRA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HILL ST
Mailing Address - Street 2:UNIT 20
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3162
Mailing Address - Country:US
Mailing Address - Phone:602-300-6317
Mailing Address - Fax:203-777-3701
Practice Address - Street 1:382 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3733
Practice Address - Country:US
Practice Address - Phone:602-300-6317
Practice Address - Fax:203-777-3701
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0011590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008043774Medicaid