Provider Demographics
NPI:1740880921
Name:CHERUKURI, NAGA SIREESHA
Entity type:Individual
Prefix:
First Name:NAGA
Middle Name:SIREESHA
Last Name:CHERUKURI
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 1:41768 CORDGRASS CIR
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5604
Mailing Address - Country:US
Mailing Address - Phone:703-732-5946
Mailing Address - Fax:
Practice Address - Street 1:9401 LIBERIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-1718
Practice Address - Country:US
Practice Address - Phone:703-257-0864
Practice Address - Fax:703-257-6356
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist