Provider Demographics
NPI:1427347798
Name:JUNNOTULA, SULOCHANA
Entity type:Individual
Prefix:MRS
First Name:SULOCHANA
Middle Name:
Last Name:JUNNOTULA
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 1:713 OBSERVATORY DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-6835
Mailing Address - Country:US
Mailing Address - Phone:302-753-3552
Mailing Address - Fax:
Practice Address - Street 1:1602 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5718
Practice Address - Country:US
Practice Address - Phone:302-453-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist