Provider Demographics
NPI:1003146002
Name:KATTA, ANAND S (RPH)
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:S
Last Name:KATTA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 NC HIGHWAY 56
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-8295
Mailing Address - Country:US
Mailing Address - Phone:919-528-1538
Mailing Address - Fax:919-528-6731
Practice Address - Street 1:1560 NC HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-8295
Practice Address - Country:US
Practice Address - Phone:919-528-1538
Practice Address - Fax:919-528-6731
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0395342Medicaid