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General NPI Number Information
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NPI Number | 1285924191
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Entity Type | Individual
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Provider Name | VISHNUVARDHAN REDDY DARAM
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Gender | Male
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 4001 DAVISON RD SUITE A
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City | BURTON
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State | MI
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Zip | 48509-1401
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Country | US
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Telephone | 810-742-0217
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Fax |
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Provider Business Mailing Address
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Address Line | 3543 CONNORS DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48307-5088
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Country | US
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Telephone | 248-270-3383
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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 | 5302036888
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License Number State | MI
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