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General NPI Number Information
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NPI Number | 1144566324
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Entity Type | Individual
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Provider Name | PRUDVI REDDY PEDAVEETI
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Gender | Male
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Dates
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Enumeration Date | 12/17/2012
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Last Update Date | 01/25/2020
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Provider Practice Location Address
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Address Line | 9155 BOURBON ST APT C
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City | LAUREL
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State | MD
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Zip | 20723-1647
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Country | US
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Telephone | 410-457-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 4528 EDMONDSON AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-1506
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Country | US
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Telephone | 410-566-5565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19263
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License Number State | MD
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