Provider Demographics
NPI:1740946243
Name:KANAKARAJAN, SUNDARAM
Entity type:Individual
Prefix:
First Name:SUNDARAM
Middle Name:
Last Name:KANAKARAJAN
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 1:2020 CR N 470 UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAKE PANASOFFKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33538
Mailing Address - Country:US
Mailing Address - Phone:352-444-2055
Mailing Address - Fax:
Practice Address - Street 1:2020 CR N 470 UNIT B
Practice Address - Street 2:
Practice Address - City:LAKE PANASOFFKEE
Practice Address - State:FL
Practice Address - Zip Code:33538-3353
Practice Address - Country:US
Practice Address - Phone:352-444-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist