Healthcare Provider Details

I. General information

NPI: 1831404383
Provider Name (Legal Business Name): MANJULA SANIKOMMU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 AMHERST ST
NASHUA NH
03064-1301
US

IV. Provider business mailing address

145 AMHERST ST
NASHUA NH
03063
US

V. Phone/Fax

Practice location:
  • Phone: 603-598-9450
  • Fax: 603-598-8103
Mailing address:
  • Phone: 603-598-9450
  • Fax: 603-598-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3400
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: