Provider Demographics
NPI:1962718221
Name:KATANGURI, DHEERAJ K
Entity type:Individual
Prefix:MR
First Name:DHEERAJ
Middle Name:K
Last Name:KATANGURI
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 1:728 E PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6029
Mailing Address - Country:US
Mailing Address - Phone:410-398-9595
Mailing Address - Fax:410-398-8179
Practice Address - Street 1:728 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6029
Practice Address - Country:US
Practice Address - Phone:410-398-9595
Practice Address - Fax:410-398-8179
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18954183500000X
DEA1-0004048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist