Provider Demographics
NPI:1083963045
Name:MANUEL, JESSE HARMON JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:HARMON
Last Name:MANUEL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CROSS ANCHOR RD
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-9654
Mailing Address - Country:US
Mailing Address - Phone:864-476-9043
Mailing Address - Fax:
Practice Address - Street 1:830 CROSS ANCHOR RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-9654
Practice Address - Country:US
Practice Address - Phone:864-476-9043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist