Provider Demographics
NPI:1487980132
Name:VASIREDDY, SREEDHAR (RPH)
Entity type:Individual
Prefix:MR
First Name:SREEDHAR
Middle Name:
Last Name:VASIREDDY
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 1:9111 OLEANDER WAY
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4282
Mailing Address - Country:US
Mailing Address - Phone:972-831-9646
Mailing Address - Fax:972-659-0494
Practice Address - Street 1:3400 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7801
Practice Address - Country:US
Practice Address - Phone:972-594-1648
Practice Address - Fax:972-659-0494
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist