Provider Demographics
NPI:1033982582
Name:GHANTA, TEJA (RPH)
Entity Type:Individual
Prefix:
First Name:TEJA
Middle Name:
Last Name:GHANTA
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 1:1816 STEFKO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-6235
Mailing Address - Country:US
Mailing Address - Phone:610-419-4198
Mailing Address - Fax:
Practice Address - Street 1:1816 STEFKO BLVD STE A
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-6235
Practice Address - Country:US
Practice Address - Phone:610-419-4198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist