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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