MEDICARE: DR. VIDYA RANGARAJ HEBBAR PH.D., R.PH.

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
1	183500000X	Pharmacist	24599	MD
2	183500000X	Pharmacist	054626-1	NY

General Provider Information

NPI Number	:	1407166861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIDYA RANGARAJ HEBBAR PH.D., R.PH.

Provider Business Mailing Address
First Line	:	6436 SWIMMER ROW WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4962
Country	:	US
Telephone Number	:	585-217-9442
Fax Number	:

Provider Business Practice Location Address
First Line	:	985 RIDGE RD
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2905
Country	:	US
Telephone Number	:	585-872-1380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	12/08/2016

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