Provider Demographics
NPI:1740689686
Name:REDDY, VIMAL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VIMAL
Middle Name:
Last Name:REDDY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-688-8761
Mailing Address - Fax:614-292-2667
Practice Address - Street 1:700 ACKERMAN RD
Practice Address - Street 2:SUITE 440
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1559
Practice Address - Country:US
Practice Address - Phone:614-688-8761
Practice Address - Fax:614-292-2667
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03234040302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization