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General NPI Number Information
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NPI Number | 1831265610
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Entity Type | Individual
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Provider Name | BALA S NADESAN PHARM.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 203 W AVENUE U
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City | TEMPLE
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State | TX
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Zip | 76504-7426
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Country | US
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Telephone | 254-791-8151
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Fax | 254-770-3183
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Provider Business Mailing Address
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Address Line | 3009 IRA YOUNG DR APT 712
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City | TEMPLE
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State | TX
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Zip | 76504-6338
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Country | US
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Telephone | 254-899-0069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835N0905X
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Taxonomy Name | Nuclear Pharmacist
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License Number | 40634
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License Number State | TX
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