Provider Demographics
NPI:1255639845
Name:EDUPUGANTI, NAGAKISHORE BABU (RPH)
Entity type:Individual
Prefix:
First Name:NAGAKISHORE
Middle Name:BABU
Last Name:EDUPUGANTI
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 1:1072 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-1766
Mailing Address - Country:US
Mailing Address - Phone:910-484-0159
Mailing Address - Fax:910-484-3270
Practice Address - Street 1:1072 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-1766
Practice Address - Country:US
Practice Address - Phone:910-484-0159
Practice Address - Fax:910-484-3270
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1962417592Medicaid
NC1801995014OtherWORK PLACE NPI#