Provider Demographics
NPI:1164738050
Name:KRISHNAN, STALIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STALIN
Middle Name:
Last Name:KRISHNAN
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 1:825 W HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3105
Mailing Address - Country:US
Mailing Address - Phone:301-797-9300
Mailing Address - Fax:301-766-9342
Practice Address - Street 1:825 W HILLCREST RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3105
Practice Address - Country:US
Practice Address - Phone:301-797-9300
Practice Address - Fax:301-766-9342
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist