Individual
SUDHEER GHANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
644 MAIN ST, MIDDLETOWN, CT 06457-2731
(860) 346-9700
Mailing address
1-74, KRISHNYAPALEM, ANDHRAPRADESH 52250-3
(864) 525-9032
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PCT0011291
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008017177
—
CT
Enumeration date
07/18/2013
Last updated
08/29/2013
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