Provider Demographics
NPI:1184009292
Name:YESU, NAGESWAR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NAGESWAR
Middle Name:
Last Name:YESU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 MADISON AVE
Mailing Address - Street 2:APT BE
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5101
Mailing Address - Country:US
Mailing Address - Phone:915-217-5258
Mailing Address - Fax:
Practice Address - Street 1:500 E EDGEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5901
Practice Address - Country:US
Practice Address - Phone:517-882-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist