Provider Demographics
NPI:1639328610
Name:GUNTAKA, PRASAD REDDY (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRASAD
Middle Name:REDDY
Last Name:GUNTAKA
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 1:392 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2411
Mailing Address - Country:US
Mailing Address - Phone:718-855-5958
Mailing Address - Fax:
Practice Address - Street 1:392 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2411
Practice Address - Country:US
Practice Address - Phone:718-855-5958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist