Healthcare Provider Details

I. General information

NPI: 1104859537
Provider Name (Legal Business Name): SANTOSH KUMAR DWARAKANATH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WASHINGTON BLVD PHARMERICA
BALTIMORE MD
21230-2350
US

IV. Provider business mailing address

6911 OLD WATERLOO RD
ELKRIDGE MD
21075-6529
US

V. Phone/Fax

Practice location:
  • Phone: 410-539-4986
  • Fax:
Mailing address:
  • Phone: 443-992-4720
  • Fax: 866-778-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17514
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: