Provider Demographics
NPI:1104559194
Name:KATTA, VENKATAKRISHNA
Entity type:Individual
Prefix:
First Name:VENKATAKRISHNA
Middle Name:
Last Name:KATTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11822 SW 152ND PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6870
Mailing Address - Country:US
Mailing Address - Phone:786-853-2440
Mailing Address - Fax:
Practice Address - Street 1:99501 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-4371
Practice Address - Country:US
Practice Address - Phone:305-451-4385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist