Provider Demographics
NPI:1871891465
Name:GADDAM, HARISH (RPH)
Entity type:Individual
Prefix:MR
First Name:HARISH
Middle Name:
Last Name:GADDAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 MOUNT HERMON RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5220
Mailing Address - Country:US
Mailing Address - Phone:410-749-0205
Mailing Address - Fax:410-749-7288
Practice Address - Street 1:1316 MOUNT HERMON RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5220
Practice Address - Country:US
Practice Address - Phone:410-749-0205
Practice Address - Fax:410-749-7288
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist