Individual
KISHOREREDDY VIJAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.PHARM
Contact information
Practice address
101 S MAIN ST, FORKED RIVER, NJ 08731-3624
(609) 242-0066
Mailing address
101 S MAIN ST, FORKED RIVER, NJ 08731-3624
(609) 242-0066
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI03175900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28RI03175900
PHARMACIST LICENSE
NJ
Enumeration date
08/18/2010
Last updated
08/18/2010
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