Provider Demographics
NPI:1053180638
Name:THAKURI, MANIMA CHAND (CPHT)
Entity type:Individual
Prefix:
First Name:MANIMA
Middle Name:CHAND
Last Name:THAKURI
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 LONESOME LILLY WAY
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5849
Mailing Address - Country:US
Mailing Address - Phone:512-736-2330
Mailing Address - Fax:
Practice Address - Street 1:1434 W WELLS BRANCH PKWY
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3153
Practice Address - Country:US
Practice Address - Phone:512-251-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283123183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician