Provider Demographics
NPI:1962007914
Name:TAKYAR, KUMUD
Entity Type:Individual
Prefix:
First Name:KUMUD
Middle Name:
Last Name:TAKYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KUMUD
Other - Middle Name:
Other - Last Name:CHOPRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6436 SPRINGFIELD PLZ
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3428
Mailing Address - Country:US
Mailing Address - Phone:703-451-1400
Mailing Address - Fax:
Practice Address - Street 1:6436 SPRINGFIELD PLZ
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3428
Practice Address - Country:US
Practice Address - Phone:703-451-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202208062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist