Organization
CITADEL INFUSION SERVICES LLC
Active
Organization
CITADEL INFUSION SERVICES LLC
Active
Other names
CITADEL INFUSION SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
SRIDEVI KATRAGADDDA (CEO)
(404) 247-9389
Entity
Organization
Contact information
Practice address
2121 NEW MARKET PKWY SE STE 126, MARIETTA, GA 30067-9309
(770) 541-1910
(770) 541-1916
Mailing address
2121 NEW MARKET PKWY SE, SUITE 126, MARIETTA, GA 30067-9315
(770) 541-1910
(770) 541-1916
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
PHRE009889
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1163079
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
12/24/2012
Last updated
12/24/2012
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