Provider Demographics
NPI:1649586579
Name:ANNAMANENI, SATYANARAYANA (RPH)
Entity Type:Individual
Prefix:
First Name:SATYANARAYANA
Middle Name:
Last Name:ANNAMANENI
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 1:338 FARNSWORTH AVE
Mailing Address - Street 2:PO BOX 227
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1709
Mailing Address - Country:US
Mailing Address - Phone:609-298-7773
Mailing Address - Fax:609-298-1504
Practice Address - Street 1:338 FARNSWORTH AVE
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-1709
Practice Address - Country:US
Practice Address - Phone:609-298-7773
Practice Address - Fax:609-298-1504
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist