Provider Demographics
NPI:1487990271
Name:CITADEL INFUSION SERVICES LLC
Entity type:Organization
Organization Name:CITADEL INFUSION SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KATRAGADDDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-247-9389
Mailing Address - Street 1:2121 NEW MARKET PKWY SE
Mailing Address - Street 2:SUITE 126
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9315
Mailing Address - Country:US
Mailing Address - Phone:770-541-1910
Mailing Address - Fax:770-541-1916
Practice Address - Street 1:2121 NEW MARKET PKWY SE STE 126
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9309
Practice Address - Country:US
Practice Address - Phone:770-541-1910
Practice Address - Fax:770-541-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-24
Last Update Date:2012-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0098893336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1163079OtherNCPDP PROVIDER IDENTIFICATION NUMBER