Provider Demographics
NPI:1790060721
Name:REDDY, MARY SUSAN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:REDDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5152 PEBBLEVALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45252
Mailing Address - Country:US
Mailing Address - Phone:513-385-4875
Mailing Address - Fax:
Practice Address - Street 1:9775 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1442
Practice Address - Country:US
Practice Address - Phone:513-385-6900
Practice Address - Fax:513-385-7634
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03117300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist