Provider Demographics
NPI:1447770789
Name:KATTA, KOUSTHUBHA
Entity Type:Individual
Prefix:
First Name:KOUSTHUBHA
Middle Name:
Last Name:KATTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7464 MIRLITON CT
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-8123
Mailing Address - Country:US
Mailing Address - Phone:614-286-6771
Mailing Address - Fax:
Practice Address - Street 1:55 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-3087
Practice Address - Country:US
Practice Address - Phone:614-890-8869
Practice Address - Fax:614-890-1193
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03327046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist