Provider Demographics
NPI:1275991820
Name:THALIATH, ASHA JOSE
Entity Type:Individual
Prefix:DR
First Name:ASHA
Middle Name:JOSE
Last Name:THALIATH
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:ASHA
Other - Middle Name:JOSE
Other - Last Name:THALIATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR OF PHARMACY
Mailing Address - Street 1:7115 TYNER CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1097
Mailing Address - Country:US
Mailing Address - Phone:423-314-8418
Mailing Address - Fax:
Practice Address - Street 1:7636 MIDDLE VALLEY RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-2237
Practice Address - Country:US
Practice Address - Phone:423-242-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist