Provider Demographics
NPI:1972896942
Name:TALASILA, GANESH KRISHNA CHAND (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:GANESH KRISHNA CHAND
Middle Name:
Last Name:TALASILA
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 1:19 BAKER AVE
Mailing Address - Street 2:SUITE207
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1359
Mailing Address - Country:US
Mailing Address - Phone:845-471-7455
Mailing Address - Fax:845-473-6337
Practice Address - Street 1:19 BAKER AVE
Practice Address - Street 2:STE 207
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-471-7455
Practice Address - Fax:845-473-6337
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03413900183500000X
NY057584-1183500000X
CTPCT0012255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY057584-1OtherSTATE LICENSE
CTPCT0012255OtherSTATE LICENSE
NJ28RI03413900OtherNJ BOARD OF PHARMACY