MEDICARE: MANDAKINI DANTULURI

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	28RI03057400	NJ

General Provider Information

NPI Number	:	1538491352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDAKINI DANTULURI

Provider Business Mailing Address
First Line	:	78 HANA RD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-2037
Country	:	US
Telephone Number	:	732-570-9402
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MAYWOOD AVE
Second Line	:
City	:	MAYWOOD
State	:	NJ
Zip	:	07607-1001
Country	:	US
Telephone Number	:	201-845-3287
Fax Number	:

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	02/03/2010

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Directions to “ MANDAKINI DANTULURI ” Practice Location

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