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General NPI Number Information
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NPI Number | 1477079614
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Entity Type | Individual
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Provider Name | VISWESWARA SASTRY KADIYAM
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Gender | Male
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 08/18/2017
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Provider Practice Location Address
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Address Line | 688 MAIN ST
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City | PATERSON
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State | NJ
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Zip | 07503-2622
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Country | US
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Telephone | 973-278-2207
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Fax |
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Provider Business Mailing Address
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Address Line | 4916 216TH ST
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City | BAYSIDE HILLS
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State | NY
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Zip | 11364-1335
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Country | US
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Telephone | 973-930-2810
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 039187-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 28RI02251100
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License Number State | NJ
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