Provider Demographics
NPI:1518559574
Name:BIJJA, ANURADHA
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:BIJJA
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 1:16 LATOUR LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4544
Mailing Address - Country:US
Mailing Address - Phone:302-750-8629
Mailing Address - Fax:
Practice Address - Street 1:218 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6650
Practice Address - Country:US
Practice Address - Phone:443-207-5105
Practice Address - Fax:443-245-3734
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist