Provider Demographics
NPI:1669075941
Name:HEGDE, RESHMA
Entity type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:HEGDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 BENTLEY CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8747
Mailing Address - Country:US
Mailing Address - Phone:678-237-8683
Mailing Address - Fax:
Practice Address - Street 1:5510 CASTLEBERRY RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8054
Practice Address - Country:US
Practice Address - Phone:770-887-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024445183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist