Provider Demographics
NPI:1447987979
Name:INAGANTI, RADHIKA D
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:D
Last Name:INAGANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N TOWN EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4601
Mailing Address - Country:US
Mailing Address - Phone:972-686-8729
Mailing Address - Fax:
Practice Address - Street 1:1015 N TOWN EAST BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4601
Practice Address - Country:US
Practice Address - Phone:972-686-8913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2024-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist