Provider Demographics
NPI:1700160967
Name:REDYSHETTY, HARIHARAPRASAD RAO (RPH)
Entity type:Individual
Prefix:MR
First Name:HARIHARAPRASAD
Middle Name:RAO
Last Name:REDYSHETTY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 ANDOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4937
Mailing Address - Country:US
Mailing Address - Phone:248-275-5635
Mailing Address - Fax:
Practice Address - Street 1:450 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3152
Practice Address - Country:US
Practice Address - Phone:248-814-7315
Practice Address - Fax:278-814-7364
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist