Provider Demographics
NPI:1750649984
Name:MATTAPARTHI, REKHA MADHAVI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:REKHA
Middle Name:MADHAVI
Last Name:MATTAPARTHI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 CARLETON TRL
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2838
Mailing Address - Country:US
Mailing Address - Phone:443-528-7498
Mailing Address - Fax:
Practice Address - Street 1:1321 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1388
Practice Address - Country:US
Practice Address - Phone:410-272-8741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist