Provider Demographics
NPI:1831469915
Name:REDDY, SHOBHA POTTIPATI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SHOBHA
Middle Name:POTTIPATI
Last Name:REDDY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 E ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4160
Mailing Address - Country:US
Mailing Address - Phone:847-231-6797
Mailing Address - Fax:
Practice Address - Street 1:6125 DURAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4913
Practice Address - Country:US
Practice Address - Phone:262-554-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI040-14332183500000X
IL051293109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist