Provider Demographics
NPI:1306526553
Name:MOTURI, MANOHAR R
Entity type:Individual
Prefix:
First Name:MANOHAR
Middle Name:R
Last Name:MOTURI
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 1:1830 TEXOMA PKWY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2616
Mailing Address - Country:US
Mailing Address - Phone:305-778-0747
Mailing Address - Fax:
Practice Address - Street 1:1830 TEXOMA PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2616
Practice Address - Country:US
Practice Address - Phone:305-778-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist