Provider Demographics
NPI:1033533534
Name:KESAVADAS, HEMANTHA NARAYAN (RPH)
Entity Type:Individual
Prefix:
First Name:HEMANTHA
Middle Name:NARAYAN
Last Name:KESAVADAS
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 1:700 N 54TH ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1502
Mailing Address - Country:US
Mailing Address - Phone:480-893-6999
Mailing Address - Fax:480-893-7639
Practice Address - Street 1:700 N 54TH ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1502
Practice Address - Country:US
Practice Address - Phone:480-893-6999
Practice Address - Fax:480-893-7639
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist