Provider Demographics
NPI:1366690661
Name:REDDY, GOVERDHAN SANDADI (RPH)
Entity Type:Individual
Prefix:MR
First Name:GOVERDHAN
Middle Name:SANDADI
Last Name:REDDY
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 1:3261 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-2518
Mailing Address - Country:US
Mailing Address - Phone:212-926-9800
Mailing Address - Fax:212-926-2228
Practice Address - Street 1:3621 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-2518
Practice Address - Country:US
Practice Address - Phone:212-926-9800
Practice Address - Fax:212-926-2228
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01293094Medicaid