MEDICARE: MR. VIJAY VASIREDDY RPH

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	044054	NY

General Provider Information

NPI Number	:	1972644128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VIJAY VASIREDDY RPH

Provider Business Mailing Address
First Line	:	217 E 106TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4005
Country	:	US
Telephone Number	:	212-534-1939
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 E 106TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-4005
Country	:	US
Telephone Number	:	212-534-1939
Fax Number	:

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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