Provider Demographics
NPI:1598064446
Name:ALLU, KIRAN KUMAR
Entity Type:Individual
Prefix:MR
First Name:KIRAN
Middle Name:KUMAR
Last Name:ALLU
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 1:50 ANGUS RUN
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-6657
Mailing Address - Country:US
Mailing Address - Phone:864-723-6837
Mailing Address - Fax:
Practice Address - Street 1:211 INGLES PL
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0848
Practice Address - Country:US
Practice Address - Phone:864-886-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist