Provider Demographics
NPI:1750697298
Name:KRISHNASWAMY, ARIKESAVANALLUR G (BS)
Entity type:Individual
Prefix:MR
First Name:ARIKESAVANALLUR
Middle Name:G
Last Name:KRISHNASWAMY
Suffix:
Gender:M
Credentials:BS
Other - Prefix:MR
Other - First Name:A
Other - Middle Name:G
Other - Last Name:KRISHNASWAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 S COOPER RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7160
Mailing Address - Country:US
Mailing Address - Phone:615-336-5194
Mailing Address - Fax:
Practice Address - Street 1:785 S COOPER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7160
Practice Address - Country:US
Practice Address - Phone:615-336-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist