Basic Information
| Provider Information | |||||||||
| NPI: | 1760082168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TENTU | ||||||||
| FirstName: | NAGALAKSHMI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23800 BENNETT CHASE DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208715316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038995312 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20910 FREDERICK RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208764134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015156703 | ||||||||
| FaxNumber: | 3015156705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 18184 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.