Provider Demographics
NPI:1093318990
Name:MANICA, ADINA
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:MANICA
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 1:1 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-1113
Mailing Address - Country:US
Mailing Address - Phone:954-524-0500
Mailing Address - Fax:954-524-8092
Practice Address - Street 1:1 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-1113
Practice Address - Country:US
Practice Address - Phone:954-524-0500
Practice Address - Fax:954-524-8092
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist