Provider Demographics
NPI:1750650438
Name:KOTWAL, MANJULA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MANJULA
Middle Name:
Last Name:KOTWAL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3490
Mailing Address - Country:US
Mailing Address - Phone:941-752-7997
Mailing Address - Fax:941-753-4555
Practice Address - Street 1:3425 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3490
Practice Address - Country:US
Practice Address - Phone:941-752-7997
Practice Address - Fax:941-753-4555
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist