Provider Demographics
NPI:1225631260
Name:MANASSEH, FREDRICK NZAI (PHARMD, MBA,BCGP)
Entity Type:Individual
Prefix:DR
First Name:FREDRICK
Middle Name:NZAI
Last Name:MANASSEH
Suffix:
Gender:M
Credentials:PHARMD, MBA,BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W PEACHTREE ST NW UNIT 2713
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3554
Mailing Address - Country:US
Mailing Address - Phone:316-841-5444
Mailing Address - Fax:
Practice Address - Street 1:1 CONCOURSE PKWY STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6128
Practice Address - Country:US
Practice Address - Phone:316-841-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55015183500000X
MO2007019773183500000X
OH03232571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist