Provider Demographics
NPI:1154878684
Name:REDDY, ANITHA
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2385 CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19150
Mailing Address - Country:US
Mailing Address - Phone:215-885-7779
Mailing Address - Fax:
Practice Address - Street 1:2800 FOX ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1838
Practice Address - Country:US
Practice Address - Phone:215-717-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440116183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist