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NPI Code Detail

MEDICARE: KISHOREREDDY VIJAYA B.PHARM

MEDICARE: KISHOREREDDY VIJAYA B.PHARM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist28RI03175900NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128RI03175900OTHERNJPHARMACIST LICENSE

General Provider Information

NPI Number : 1205141991
Entity Type Code : Individual
Provider Name (Legal Business Name) : KISHOREREDDY VIJAYA B.PHARM
Provider Business Mailing Address
First Line : 101 S MAIN ST
Second Line :
City : FORKED RIVER
State : NJ
Zip : 08731-3624
Country : US
Telephone Number : 609-242-0066
Fax Number :
Provider Business Practice Location Address
First Line : 101 S MAIN ST
Second Line :
City : FORKED RIVER
State : NJ
Zip : 08731-3624
Country : US
Telephone Number : 609-242-0066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2010
Last Update Date : 08/18/2010

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Directions to “ KISHOREREDDY VIJAYA B.PHARM” Practice Location

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