MEDICARE: MRS. ANURADHA MANCHIKANTI R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	012224	KY

General Provider Information

NPI Number	:	1023015633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANURADHA MANCHIKANTI R.PH

Provider Business Mailing Address
First Line	:	305 FOREST RIDGE DR
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42003-8009
Country	:	US
Telephone Number	:	270-554-7744
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 BROADWAY ST
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-0713
Country	:	US
Telephone Number	:	270-538-0772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	07/08/2007

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