Provider Demographics
NPI:1386199420
Name:MACHA, SUBHASHINI
Entity type:Individual
Prefix:
First Name:SUBHASHINI
Middle Name:
Last Name:MACHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 ENCHANTED WAY
Mailing Address - Street 2:103-A
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-0965
Mailing Address - Country:US
Mailing Address - Phone:972-914-4990
Mailing Address - Fax:800-874-4085
Practice Address - Street 1:1940 ENCHANTED WAY
Practice Address - Street 2:103-A
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-0965
Practice Address - Country:US
Practice Address - Phone:972-914-4990
Practice Address - Fax:800-874-4085
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist