Provider Demographics
NPI:1356478895
Name:MANNAVA, VENKATA SRINIVAS (RPH)
Entity Type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:SRINIVAS
Last Name:MANNAVA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 FLORIDA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1875
Mailing Address - Country:US
Mailing Address - Phone:202-387-1600
Mailing Address - Fax:202-387-1800
Practice Address - Street 1:651 FLORIDA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1875
Practice Address - Country:US
Practice Address - Phone:202-387-1600
Practice Address - Fax:202-387-1800
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPH100000749OtherLICENSE NUMBER