Provider Demographics
NPI:1235852039
Name:KRISHNAN, ANIRUDH (RPH)
Entity Type:Individual
Prefix:
First Name:ANIRUDH
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 1:252 HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6242
Mailing Address - Country:US
Mailing Address - Phone:908-619-4494
Mailing Address - Fax:
Practice Address - Street 1:690 MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-3756
Practice Address - Country:US
Practice Address - Phone:973-895-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04269000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist