Provider Demographics
NPI:1154620391
Name:CHAKRAVARTHULA, KRISHNA (BPHARMACY,MPH)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:CHAKRAVARTHULA
Suffix:
Gender:M
Credentials:BPHARMACY,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 BAILEYS RIDGE DR APT 13
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1467
Mailing Address - Country:US
Mailing Address - Phone:405-474-0934
Mailing Address - Fax:
Practice Address - Street 1:2305 OAKLAWN BLVD
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-5032
Practice Address - Country:US
Practice Address - Phone:804-458-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist