Provider Demographics
NPI:1528470606
Name:KRISHNASWAMY, GOVINDARAJULU (BS IN PHARMACY)
Entity type:Individual
Prefix:
First Name:GOVINDARAJULU
Middle Name:
Last Name:KRISHNASWAMY
Suffix:
Gender:M
Credentials:BS IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W MENDOZA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-7515
Mailing Address - Country:US
Mailing Address - Phone:480-813-4359
Mailing Address - Fax:
Practice Address - Street 1:1845 E. BASELINE ROAD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-539-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ099991835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy