Provider Demographics
NPI:1487965059
Name:MADALA HALAGAPPA, VEERENDRA KUMAR (PHARMACIST)
Entity type:Individual
Prefix:
First Name:VEERENDRA KUMAR
Middle Name:
Last Name:MADALA HALAGAPPA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12402 GREAT PARK CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5962
Mailing Address - Country:US
Mailing Address - Phone:410-299-9973
Mailing Address - Fax:
Practice Address - Street 1:19927 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7120
Practice Address - Country:US
Practice Address - Phone:301-972-4861
Practice Address - Fax:301-972-2539
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist