Provider Demographics
NPI:1306304779
Name:KUNAMNENI, PRATHYUSHA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PRATHYUSHA
Middle Name:
Last Name:KUNAMNENI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12883 RISEN STAR RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1539
Mailing Address - Country:US
Mailing Address - Phone:248-633-6322
Mailing Address - Fax:
Practice Address - Street 1:5350 INDEPENDENCE PKWY # 110A
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4652
Practice Address - Country:US
Practice Address - Phone:469-885-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04004600183500000X
TX65589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist