Provider Demographics
NPI:1720368293
Name:KUMARI, ACHALA S (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:ACHALA
Middle Name:S
Last Name:KUMARI
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2832
Mailing Address - Country:US
Mailing Address - Phone:630-357-6820
Mailing Address - Fax:
Practice Address - Street 1:713 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2832
Practice Address - Country:US
Practice Address - Phone:630-357-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051288060183500000X
TX49816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist