Provider Demographics
NPI:1720420151
Name:BANDARUPALLI, VEERAIAHCHOWDARY
Entity Type:Individual
Prefix:
First Name:VEERAIAHCHOWDARY
Middle Name:
Last Name:BANDARUPALLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1928
Mailing Address - Country:US
Mailing Address - Phone:240-367-4571
Mailing Address - Fax:203-368-4872
Practice Address - Street 1:1407 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1928
Practice Address - Country:US
Practice Address - Phone:203-367-4571
Practice Address - Fax:203-368-4872
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist