Provider Demographics
NPI:1093288722
Name:PRADHAN, MANOJ (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:PRADHAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 KINGS TROOP RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4707
Mailing Address - Country:US
Mailing Address - Phone:404-936-8350
Mailing Address - Fax:
Practice Address - Street 1:4051 STONE MOUNTAIN HWY STE D101
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3364
Practice Address - Country:US
Practice Address - Phone:404-936-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist