Provider Demographics
NPI:1568873966
Name:NUKALA, DHIRAJ JR (RPH)
Entity Type:Individual
Prefix:
First Name:DHIRAJ
Middle Name:
Last Name:NUKALA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 S AVENUE B
Mailing Address - Street 2:APT 5
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4350
Mailing Address - Country:US
Mailing Address - Phone:928-819-0208
Mailing Address - Fax:928-810-0599
Practice Address - Street 1:1555 S AVENUE B
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4584
Practice Address - Country:US
Practice Address - Phone:928-819-0208
Practice Address - Fax:928-819-0599
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016489183500000X
VT0330003800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist