Provider Demographics
NPI:1558755447
Name:BHEEMIREDDY, REKHA
Entity Type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:BHEEMIREDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SKIFF ST APT B512
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-1858
Mailing Address - Country:US
Mailing Address - Phone:203-645-1450
Mailing Address - Fax:
Practice Address - Street 1:1030 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4985
Practice Address - Country:US
Practice Address - Phone:203-378-9394
Practice Address - Fax:203-375-8651
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT0013181183500000X
FLPS52816183500000X
NJ28RI03686900183500000X
TX56002183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist