Provider Demographics
NPI:1609123280
Name:NANDYALA, SRINIVASA KUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SRINIVASA
Middle Name:KUMAR
Last Name:NANDYALA
Suffix:
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 1:114 KILMAYNE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4465
Mailing Address - Country:US
Mailing Address - Phone:919-678-5027
Mailing Address - Fax:919-678-5037
Practice Address - Street 1:114 KILMAYNE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4465
Practice Address - Country:US
Practice Address - Phone:919-678-5027
Practice Address - Fax:919-678-5037
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist