Provider Demographics
NPI:1699448548
Name:SELVAKUMAR, KOUSALYA (DR)
Entity type:Individual
Prefix:
First Name:KOUSALYA
Middle Name:
Last Name:SELVAKUMAR
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:KOUSALYA
Other - Middle Name:
Other - Last Name:JAGANNATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DR
Mailing Address - Street 1:804 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-4624
Mailing Address - Country:US
Mailing Address - Phone:603-892-1579
Mailing Address - Fax:
Practice Address - Street 1:2605 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5433
Practice Address - Country:US
Practice Address - Phone:910-484-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist