Provider Demographics
NPI:1861711699
Name:MUSKU, SATISH REDDY
Entity type:Individual
Prefix:
First Name:SATISH
Middle Name:REDDY
Last Name:MUSKU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LATOUR LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4544
Mailing Address - Country:US
Mailing Address - Phone:302-220-0909
Mailing Address - Fax:
Practice Address - Street 1:1003 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2603
Practice Address - Country:US
Practice Address - Phone:410-939-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17099183500000X
NJ28RI03274000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist