MEDICARE: VIJAYA BHASKARA REDDY GANGIREDDY

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	3568	NH
2	183500000X	Pharmacist	PS43667	FL
3	183500000X	Pharmacist	47271	TX

General Provider Information

NPI Number	:	1407458516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAYA BHASKARA REDDY GANGIREDDY

Provider Business Mailing Address
First Line	:	8752 MEDICAL CITY WAY STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2497
Country	:	US
Telephone Number	:	682-710-7777
Fax Number	:	844-328-4814

Provider Business Practice Location Address
First Line	:	8752 MEDICAL CITY WAY STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2497
Country	:	US
Telephone Number	:	682-710-7777
Fax Number	:	844-328-4814

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

Provider Enumeration Date	:	11/12/2020
Last Update Date	:	10/06/2025

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