Provider Demographics
NPI:1780008474
Name:CHINAPAGA, ANIL (RPH)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:
Last Name:CHINAPAGA
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 1:69 RHODODENDRON DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2763
Mailing Address - Country:US
Mailing Address - Phone:336-245-9181
Mailing Address - Fax:
Practice Address - Street 1:69 RHODODENDRON DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2763
Practice Address - Country:US
Practice Address - Phone:336-245-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC18703OtherRPH LICENSE