Provider Demographics
NPI:1891418299
Name:NAYAKUDUGARI, MOUNICA B
Entity Type:Individual
Prefix:
First Name:MOUNICA
Middle Name:B
Last Name:NAYAKUDUGARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 LAPORTE RD # 2
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8324
Mailing Address - Country:US
Mailing Address - Phone:732-881-2512
Mailing Address - Fax:
Practice Address - Street 1:502 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-1633
Practice Address - Country:US
Practice Address - Phone:802-748-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0330134725183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist