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General NPI Number Information
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NPI Number | 1699101212
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Entity Type | Individual
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Provider Name | SRINIVASA REDDY YANNAM MS PHARMACY
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Gender | Male
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 2262 WEBSTER AVE
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City | BRONX
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State | NY
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Zip | 10457-1302
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Country | US
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Telephone | 718-733-4150
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Fax |
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Provider Business Mailing Address
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Address Line | 963 MAIN ST APT 1A
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City | HACKENSACK
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State | NJ
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Zip | 07601-5145
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Country | US
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Telephone | 347-443-7875
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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 | 057640-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0011922
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License Number State | CT
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