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NPI Code Detail

MEDICARE: SHANTAN R REDDY PHARMACIST

MEDICARE: SHANTAN R REDDY PHARMACIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPR5816ME

General Provider Information

NPI Number : 1396054714
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTAN R REDDY PHARMACIST
Provider Business Mailing Address
First Line : 35 PARK ST
Second Line :
City : MILO
State : ME
Zip : 04401
Country : US
Telephone Number : 207-943-8750
Fax Number : 207-943-5248
Provider Business Practice Location Address
First Line : 35 PARK ST
Second Line :
City : MILO
State : ME
Zip : 04463-1152
Country : US
Telephone Number : 207-943-8750
Fax Number : 207-943-5248
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2010
Last Update Date : 10/04/2010

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Directions to “ SHANTAN R REDDY PHARMACIST” Practice Location

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