Provider Demographics
NPI:1407458516
Name:GANGIREDDY, VIJAYA BHASKARA REDDY
Entity type:Individual
Prefix:
First Name:VIJAYA
Middle Name:BHASKARA REDDY
Last Name:GANGIREDDY
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 1:8752 MEDICAL CITY WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2497
Mailing Address - Country:US
Mailing Address - Phone:682-710-7777
Mailing Address - Fax:844-328-4814
Practice Address - Street 1:8752 MEDICAL CITY WAY STE 120
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-2497
Practice Address - Country:US
Practice Address - Phone:682-710-7777
Practice Address - Fax:844-328-4814
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3568183500000X
FLPS43667183500000X
TX47271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist