Provider Demographics
NPI:1063720175
Name:PUTTA, NEERAJA (RPH)
Entity type:Individual
Prefix:
First Name:NEERAJA
Middle Name:
Last Name:PUTTA
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 1:9840 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2040
Mailing Address - Country:US
Mailing Address - Phone:301-253-6288
Mailing Address - Fax:
Practice Address - Street 1:6970 CRESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7239
Practice Address - Country:US
Practice Address - Phone:301-682-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist