Provider Demographics
NPI:1497156111
Name:VIJAYASREE LLC
Entity Type:Organization
Organization Name:VIJAYASREE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SREEDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDALAPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-419-4198
Mailing Address - Street 1:1816 STEFKO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-6235
Mailing Address - Country:US
Mailing Address - Phone:610-419-4198
Mailing Address - Fax:610-419-4252
Practice Address - Street 1:1816 STEFKO BLVD STE A
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-6235
Practice Address - Country:US
Practice Address - Phone:610-419-4198
Practice Address - Fax:610-419-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies