Provider Demographics
NPI:1720319684
Name:MASIREDDY, ESWAR REDDY (BPHARM)
Entity Type:Individual
Prefix:MR
First Name:ESWAR REDDY
Middle Name:
Last Name:MASIREDDY
Suffix:
Gender:M
Credentials:BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 S 14TH AVE
Mailing Address - Street 2:UNIT 80
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6275
Mailing Address - Country:US
Mailing Address - Phone:928-328-1945
Mailing Address - Fax:
Practice Address - Street 1:2081 S 4TH AVE
Practice Address - Street 2:28TH ST
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-328-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD05980915OtherDRIVERS LICENSE