Provider Demographics
NPI:1750666517
Name:GUTTA, RADHIKA
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:GUTTA
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 1:14061 LOTUS LN APT 1012
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-7403
Mailing Address - Country:US
Mailing Address - Phone:781-354-8363
Mailing Address - Fax:
Practice Address - Street 1:25421 EASTERN MARKETPLACE PLZ
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5780
Practice Address - Country:US
Practice Address - Phone:703-327-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist