Provider Demographics
NPI:1689965758
Name:AKKINENI, PURNACHANDRA RAO (RPH)
Entity Type:Individual
Prefix:MR
First Name:PURNACHANDRA
Middle Name:RAO
Last Name:AKKINENI
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 1:9 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5500
Mailing Address - Country:US
Mailing Address - Phone:718-774-9613
Mailing Address - Fax:718-774-9666
Practice Address - Street 1:964 RUTLAND RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1544
Practice Address - Country:US
Practice Address - Phone:718-774-9613
Practice Address - Fax:718-774-9666
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042559183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist