=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093947673
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GANESH INAPAKOLLA PHARMAIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2009
-----------------------------------------------------
Last Update Date | 11/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 563 E TREMONT AVE
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10457-4655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-466-4700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 HICKORY AVE APT E3
-----------------------------------------------------
City | BERGENFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07621-4621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-790-8163
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 20293
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------