Provider Demographics
NPI:1851829261
Name:KANNAN, KUMARAN (RPH)
Entity Type:Individual
Prefix:
First Name:KUMARAN
Middle Name:
Last Name:KANNAN
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 1:200 WILLIAM HENRY WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-9369
Mailing Address - Country:US
Mailing Address - Phone:517-775-1817
Mailing Address - Fax:
Practice Address - Street 1:5859 TRYON RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9311
Practice Address - Country:US
Practice Address - Phone:919-233-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034307183500000X
NC24477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist