Healthcare Provider Details

I. General information

NPI: 1821170614
Provider Name (Legal Business Name): VD & SR PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 PARK AVE
BALTIMORE MD
21217-4280
US

IV. Provider business mailing address

1535 PARK AVE
BALTIMORE MD
21217-4280
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-0800
  • Fax: 410-523-3434
Mailing address:
  • Phone: 410-225-0800
  • Fax: 410-523-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06708
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SYAM POTLURI
Title or Position: MANAGING MEMBER
Credential: RPH
Phone: 443-823-3350