Provider Demographics
NPI:1801194931
Name:POPURI, CHENCHU R (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHENCHU
Middle Name:R
Last Name:POPURI
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 1:501 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-2156
Mailing Address - Country:US
Mailing Address - Phone:717-233-5344
Mailing Address - Fax:
Practice Address - Street 1:501 S 29TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-2156
Practice Address - Country:US
Practice Address - Phone:717-233-5344
Practice Address - Fax:717-236-5095
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP441737OtherSTATE LICENSE