Provider Demographics
NPI:1861771842
Name:MERUGU, ANITHA
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:MERUGU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WALDRON DR
Mailing Address - Street 2:FL-2
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2407
Mailing Address - Country:US
Mailing Address - Phone:845-300-1916
Mailing Address - Fax:
Practice Address - Street 1:435 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2356
Practice Address - Country:US
Practice Address - Phone:973-546-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03409800183500000X
NY055361183500000X
MI5302036799183500000X
CTPCT.0011552183500000X
PARP445812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist