Provider Demographics
NPI:1417989534
Name:REDA PHARMACY LTD
Entity Type:Organization
Organization Name:REDA PHARMACY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:845-425-8787
Mailing Address - Street 1:811 CHESTNUT RIDGE RD
Mailing Address - Street 2:THE BARN STORE G
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6330
Mailing Address - Country:US
Mailing Address - Phone:845-425-8787
Mailing Address - Fax:
Practice Address - Street 1:811 CHESTNUT RIDGE RD
Practice Address - Street 2:THE BARN STORE G
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-6330
Practice Address - Country:US
Practice Address - Phone:845-425-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0158173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3363099OtherNABP
NY00392690Medicaid