Provider Demographics
NPI:1508156860
Name:KATRAGADDA, RADHAKRISHNA (RPH)
Entity Type:Individual
Prefix:MR
First Name:RADHAKRISHNA
Middle Name:
Last Name:KATRAGADDA
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 1:745 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4705
Mailing Address - Country:US
Mailing Address - Phone:201-521-0546
Mailing Address - Fax:201-521-0546
Practice Address - Street 1:745 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4705
Practice Address - Country:US
Practice Address - Phone:201-521-0546
Practice Address - Fax:201-521-0546
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03138400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03138400OtherNCPDP :3197755
NJ28RS00711100OtherNPI : 1184923823