Individual
SUDHARSAN PERIYASAMY THANDAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2744 WASHINGTON RD, AUGUSTA, GA 30909-2218
(706) 733-4277
Mailing address
2744 WASHINGTON RD, AUGUSTA, GA 30909-2218
(706) 733-4277
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH028705
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UIJ945A15732
BLUECROSS BLUESHEILD
GA
Enumeration date
12/14/2015
Last updated
12/14/2015
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