Provider Demographics
NPI:1154649085
Name:KAMMA, RAJENDRA PRASAD
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:PRASAD
Last Name:KAMMA
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 1:3820 MOUNTAIN RD STE G
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2027
Mailing Address - Country:US
Mailing Address - Phone:410-255-0099
Mailing Address - Fax:410-255-0799
Practice Address - Street 1:3820 MOUNTAIN RD STE G
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2027
Practice Address - Country:US
Practice Address - Phone:410-255-0099
Practice Address - Fax:410-255-0799
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist