Provider Demographics
NPI:1982067872
Name:MANDADI, JANAREDDY
Entity Type:Individual
Prefix:
First Name:JANAREDDY
Middle Name:
Last Name:MANDADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 MCARDLE RD
Mailing Address - Street 2:APT-34
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4246
Mailing Address - Country:US
Mailing Address - Phone:361-345-4656
Mailing Address - Fax:361-345-4647
Practice Address - Street 1:1335 SANTA FE
Practice Address - Street 2:SHORELINE PHARMACY
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-678-4475
Practice Address - Fax:361-232-4040
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist