MEDICARE: JESSICA ANN MENACHERY PHARM.D

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	22533	MD
2	183500000X	Pharmacist	PH100001770	DC

General Provider Information

NPI Number	:	1245637024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ANN MENACHERY PHARM.D

Provider Business Mailing Address
First Line	:	13502 DEERBROOK DR
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-6328
Country	:	US
Telephone Number	:	301-461-6706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 E WEST HWY
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3242
Country	:	US
Telephone Number	:	301-588-6261
Fax Number	:

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

Provider Enumeration Date	:	11/22/2014
Last Update Date	:	11/22/2014

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