Provider Demographics
NPI:1629666193
Name:ABBAREDDY, RAJENDAR REDDY
Entity Type:Individual
Prefix:MR
First Name:RAJENDAR
Middle Name:REDDY
Last Name:ABBAREDDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-2227
Mailing Address - Country:US
Mailing Address - Phone:804-443-3461
Mailing Address - Fax:
Practice Address - Street 1:517 CHURCH LN
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-2227
Practice Address - Country:US
Practice Address - Phone:804-443-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist