Individual
MANISHA MUDALIAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1970 W GRANT LINE RD, TRACY, CA 95376-8812
(209) 830-7388
Mailing address
659 N SAN MARCOS DR, MOUNTAIN HOUSE, CA 95391-1236
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
103955
CA
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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