Provider Demographics
NPI:1104859537
Name:DWARAKANATH, SANTOSH KUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SANTOSH
Middle Name:KUMAR
Last Name:DWARAKANATH
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 1:6911 OLD WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6529
Mailing Address - Country:US
Mailing Address - Phone:443-992-4720
Mailing Address - Fax:866-778-6726
Practice Address - Street 1:700 WASHINGTON BLVD
Practice Address - Street 2:PHARMERICA
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2350
Practice Address - Country:US
Practice Address - Phone:410-539-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist