Provider Demographics
NPI:1336498765
Name:THADISINA, ASHA REDDY (PHARM D)
Entity Type:Individual
Prefix:
First Name:ASHA REDDY
Middle Name:
Last Name:THADISINA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NORMANDY CT
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2977
Mailing Address - Country:US
Mailing Address - Phone:901-262-9380
Mailing Address - Fax:
Practice Address - Street 1:525 COUNTY ROAD 515
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462
Practice Address - Country:US
Practice Address - Phone:973-764-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03503300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist