Provider Demographics
NPI:1720377104
Name:DHARMALA, KIRAN
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:DHARMALA
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 1:270 COLONNADE DR APT 16
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4961
Mailing Address - Country:US
Mailing Address - Phone:816-728-7802
Mailing Address - Fax:540-727-0183
Practice Address - Street 1:590 MADISON RD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3374
Practice Address - Country:US
Practice Address - Phone:540-727-0483
Practice Address - Fax:540-727-0184
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist