Healthcare Provider Details

I. General information

NPI: 1831497064
Provider Name (Legal Business Name): MR. VEERA REDDY GUDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2011
Last Update Date: 03/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 WESTGATE RD
PETERSBURG VA
23803-6571
US

IV. Provider business mailing address

4310 WESTGATE RD
PETERSBURG VA
23803-6571
US

V. Phone/Fax

Practice location:
  • Phone: 804-732-0719
  • Fax: 804-733-7609
Mailing address:
  • Phone: 804-732-0719
  • Fax: 804-733-7609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207785
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: