Healthcare Provider Details

I. General information

NPI: 1447770789
Provider Name (Legal Business Name): KOUSTHUBHA KATTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 N HIGH ST
COLUMBUS OH
43214-4051
US

IV. Provider business mailing address

7464 MIRLITON CT
GALENA OH
43021-8123
US

V. Phone/Fax

Practice location:
  • Phone: 614-263-1796
  • Fax: 614-263-1840
Mailing address:
  • Phone: 614-286-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03327046
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: