Healthcare Provider Details

I. General information

NPI: 1275442063
Provider Name (Legal Business Name): HETERO CARE TRADERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 HUNTER RIDGE LN
NORCROSS GA
30092-3759
US

IV. Provider business mailing address

3870 PEACHTREE INDUSTRIAL BLVD STE 340
DULUTH GA
30096-1474
US

V. Phone/Fax

Practice location:
  • Phone: 943-204-7580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HARICHARANTEJA MADDURI
Title or Position: MD
Credential:
Phone: 943-204-7580