Provider Demographics
NPI:1831265610
Name:NADESAN, BALA S (PHARMD, PHD)
Entity type:Individual
Prefix:DR
First Name:BALA
Middle Name:S
Last Name:NADESAN
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 IRA YOUNG DR APT 712
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6338
Mailing Address - Country:US
Mailing Address - Phone:254-899-0069
Mailing Address - Fax:
Practice Address - Street 1:203 W AVENUE U
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7426
Practice Address - Country:US
Practice Address - Phone:254-791-8151
Practice Address - Fax:254-770-3183
Is Sole Proprietor?:No
Enumeration Date:2006-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX406341835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear