Individual
KISHORE PERUMANDLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 LAKE HAVASU AVE S, LAKE HAVASU CITY, AZ 86403-6565
(928) 453-2808
(928) 453-2619
Mailing address
25 LAKE HAVASU AVE S, LAKE HAVASU CITY, AZ 86403-6565
(928) 453-2808
(928) 453-2619
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S016413
AZ
Other
Enumeration date
07/20/2010
Last updated
07/20/2010
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