Provider Demographics
NPI:1245520451
Name:KESHARY, PRAKASH
Entity type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:
Last Name:KESHARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HARVEST GLN
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1556
Mailing Address - Country:US
Mailing Address - Phone:860-691-2403
Mailing Address - Fax:
Practice Address - Street 1:35 HARVEST GLN
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1556
Practice Address - Country:US
Practice Address - Phone:860-691-2403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033127-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist