Provider Demographics
NPI:1356993513
Name:MACHANDAENG, ARUNSRI (RPH)
Entity type:Individual
Prefix:
First Name:ARUNSRI
Middle Name:
Last Name:MACHANDAENG
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 1:14300 TERRA BELLA ST UNIT 96
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6756
Mailing Address - Country:US
Mailing Address - Phone:818-429-9624
Mailing Address - Fax:
Practice Address - Street 1:602 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-2207
Practice Address - Country:US
Practice Address - Phone:619-321-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH80628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist