Provider Demographics
NPI:1366876674
Name:SEETARAM, MANDATH MANNY (PHARMD,,BCPS)
Entity type:Individual
Prefix:DR
First Name:MANDATH
Middle Name:MANNY
Last Name:SEETARAM
Suffix:
Gender:M
Credentials:PHARMD,,BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9195 NUGENT TRL
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6325
Mailing Address - Country:US
Mailing Address - Phone:561-714-7229
Mailing Address - Fax:
Practice Address - Street 1:9195 NUGENT TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6325
Practice Address - Country:US
Practice Address - Phone:561-714-7229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS336561835P0018X
FLPU55351835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy