Provider Demographics
NPI:1891007662
Name:KATTA, TANUJA (RPH)
Entity Type:Individual
Prefix:
First Name:TANUJA
Middle Name:
Last Name:KATTA
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 1:11709 FAIR OAKS WAY
Mailing Address - Street 2:SHEFFIELD
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3192
Mailing Address - Country:US
Mailing Address - Phone:301-768-9117
Mailing Address - Fax:
Practice Address - Street 1:3385 CRAIN HIGH WAY
Practice Address - Street 2:RITE AID 11197
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603
Practice Address - Country:US
Practice Address - Phone:301-396-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist