Basic Information
| Provider Information | |||||||||
| NPI: | 1003146002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KATTA | ||||||||
| FirstName: | ANAND | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 NC HIGHWAY 56 | ||||||||
| Address2: | |||||||||
| City: | CREEDMOOR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275228295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195281538 | ||||||||
| FaxNumber: | 9195286731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1560 NC HIGHWAY 56 | ||||||||
| Address2: | |||||||||
| City: | CREEDMOOR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275228295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195281538 | ||||||||
| FaxNumber: | 9195286731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2010 | ||||||||
| LastUpdateDate: | 01/13/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 19471 | NC | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 0395342 | 05 | NC | MEDICAID |