MEDICARE: MS. LAKSHMI DEEPA HANUMANTHU

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	60283	CA

General Provider Information

NPI Number	:	1205143849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAKSHMI DEEPA HANUMANTHU

Provider Business Mailing Address
First Line	:	780 OAK GROVE RD
Second Line	:	APT D206
City	:	CONCORD
State	:	CA
Zip	:	94518-2723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 MAIN ST
Second Line	:
City	:	OAKLEY
State	:	CA
Zip	:	94561-1853
Country	:	US
Telephone Number	:	925-625-7440
Fax Number	:

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	09/02/2010

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