Provider Demographics
NPI:1912477597
Name:IYER, GANESHAN S
Entity Type:Individual
Prefix:
First Name:GANESHAN
Middle Name:S
Last Name:IYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GANESHAN
Other - Middle Name:
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14916 TALKING ROCK CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-706-8382
Mailing Address - Fax:
Practice Address - Street 1:26075 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1831
Practice Address - Country:US
Practice Address - Phone:301-253-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist