Provider Demographics
NPI:1447537956
Name:KANCHARLA, RAGHU
Entity type:Individual
Prefix:
First Name:RAGHU
Middle Name:
Last Name:KANCHARLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 KIMBALL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4409
Mailing Address - Country:US
Mailing Address - Phone:262-408-8696
Mailing Address - Fax:
Practice Address - Street 1:4395 KIMBALL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-4409
Practice Address - Country:US
Practice Address - Phone:678-566-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14565-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist