Healthcare Provider Details

I. General information

NPI: 1366367054
Provider Name (Legal Business Name): RAGHUNATHA REDDY PALLERLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7571 RITCHIE HWY
GLEN BURNIE MD
21061-3798
US

IV. Provider business mailing address

7571 RITCHIE HWY
GLEN BURNIE MD
21061-3798
US

V. Phone/Fax

Practice location:
  • Phone: 410-746-1344
  • Fax: 410-590-1986
Mailing address:
  • Phone: 410-761-3443
  • Fax: 410-590-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14391
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: