Provider Demographics
NPI:1306446919
Name:DEVINENI, DURGA B
Entity type:Individual
Prefix:MS
First Name:DURGA
Middle Name:B
Last Name:DEVINENI
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 1:107 BORDEAUX CT
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4588
Mailing Address - Country:US
Mailing Address - Phone:972-322-9309
Mailing Address - Fax:
Practice Address - Street 1:3060 JUSTIN RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7047
Practice Address - Country:US
Practice Address - Phone:972-317-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist