Provider Demographics
NPI:1477102762
Name:KUKREJA, MEENA
Entity type:Individual
Prefix:
First Name:MEENA
Middle Name:
Last Name:KUKREJA
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 1:607 E ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-7126
Mailing Address - Country:US
Mailing Address - Phone:813-703-1500
Mailing Address - Fax:813-703-1505
Practice Address - Street 1:607 E ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-7126
Practice Address - Country:US
Practice Address - Phone:813-703-1500
Practice Address - Fax:813-703-1505
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist