MEDICARE: MR. GOVERDHAN SANDADI REDDY R.PH

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
1	183500000X	Pharmacist	031336	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366690661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GOVERDHAN SANDADI REDDY R.PH

Provider Business Mailing Address
First Line	:	3261 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-2518
Country	:	US
Telephone Number	:	212-926-9800
Fax Number	:	212-926-2228

Provider Business Practice Location Address
First Line	:	3621 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-2518
Country	:	US
Telephone Number	:	212-926-9800
Fax Number	:	212-926-2228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	08/29/2008

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