Provider Demographics
NPI:1588227136
Name:BIKKUMALLA, SUNEETHA
Entity Type:Individual
Prefix:
First Name:SUNEETHA
Middle Name:
Last Name:BIKKUMALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6036 W HOOVER LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-6891
Mailing Address - Country:US
Mailing Address - Phone:720-273-9375
Mailing Address - Fax:
Practice Address - Street 1:10900 E BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3820
Practice Address - Country:US
Practice Address - Phone:303-706-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.20660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty