Provider Demographics
NPI:1043798671
Name:REDDY, K-N-RAM MOHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:K-N-RAM
Middle Name:MOHAN
Last Name:REDDY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13646 ESCORT DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-4496
Mailing Address - Country:US
Mailing Address - Phone:210-274-0455
Mailing Address - Fax:
Practice Address - Street 1:6580 FM 78
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1300
Practice Address - Country:US
Practice Address - Phone:210-666-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist