Provider Demographics
NPI:1811235336
Name:KATRAGADDA, SRIDEVI
Entity Type:Individual
Prefix:MRS
First Name:SRIDEVI
Middle Name:
Last Name:KATRAGADDA
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 1:4442 STERLING POINTE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7347
Mailing Address - Country:US
Mailing Address - Phone:770-419-7455
Mailing Address - Fax:
Practice Address - Street 1:805 FRANKLIN CT SE
Practice Address - Street 2:A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8942
Practice Address - Country:US
Practice Address - Phone:770-420-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist