Provider Demographics
NPI:1174124192
Name:THANKI, RAJEN L
Entity type:Individual
Prefix:
First Name:RAJEN
Middle Name:L
Last Name:THANKI
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 1:2522 BARRETT SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-3817
Mailing Address - Country:US
Mailing Address - Phone:314-680-0786
Mailing Address - Fax:
Practice Address - Street 1:13455 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1711
Practice Address - Country:US
Practice Address - Phone:314-822-2006
Practice Address - Fax:314-822-0738
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist