Provider Demographics
NPI:1003123159
Name:DASARI, VINAY KUMAR REDDY (RPH)
Entity Type:Individual
Prefix:
First Name:VINAY KUMAR
Middle Name:REDDY
Last Name:DASARI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 EASTERN BLVD
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221
Mailing Address - Country:US
Mailing Address - Phone:410-780-7020
Mailing Address - Fax:410-780-3946
Practice Address - Street 1:1340 EASTERN BLVD
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221
Practice Address - Country:US
Practice Address - Phone:410-780-7020
Practice Address - Fax:410-780-3946
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16744183500000X
NC20963183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist