Provider Demographics
NPI:1659527075
Name:REDDY MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:REDDY MEDICAL ASSOCIATES PC
Other - Org Name:BOONSBORO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:NERAVETLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-329-0077
Mailing Address - Street 1:4925 BOONSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2207
Mailing Address - Country:US
Mailing Address - Phone:434-455-1211
Mailing Address - Fax:434-455-1201
Practice Address - Street 1:4925 BOONSBORO RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2207
Practice Address - Country:US
Practice Address - Phone:434-455-1211
Practice Address - Fax:434-455-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0210004238332B00000X
VA02010042383336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0201004238OtherPHARMACY LICENSE