MEDICARE: MANOHARAN BALAKRISHNAN 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	03-3-14144	OH

General Provider Information

NPI Number	:	1336109354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANOHARAN BALAKRISHNAN R.PH

Provider Business Mailing Address
First Line	:	1910 SERENA AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93619-2844
Country	:	US
Telephone Number	:	559-324-9379
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 E CLINITON AVE
Second Line	:	VA CENTRAL HEALTH CARE SYSTEM
City	:	FRESNO
State	:	CA
Zip	:	93703-2286
Country	:	US
Telephone Number	:	559-225-6100
Fax Number	:	559-241-6496

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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