Provider Demographics
NPI:1043970072
Name:MANFRIA, NICOLE (RPH, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:MANFRIA
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 BROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4394
Mailing Address - Country:US
Mailing Address - Phone:973-429-0444
Mailing Address - Fax:973-429-0440
Practice Address - Street 1:194 BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4394
Practice Address - Country:US
Practice Address - Phone:973-429-0444
Practice Address - Fax:973-429-0440
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI034063001835P1200X
CTPCT.00110421835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.0011042OtherSTATE PHARMACIST LICENSE
NJ28RI03406300OtherSTATE PHARMACIST LICENSE