Provider Demographics
NPI:1245602499
Name:JOSE, MANU JOHN (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MANU
Middle Name:JOHN
Last Name:JOSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S HIGHWAY 395
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2620
Mailing Address - Country:US
Mailing Address - Phone:541-567-7805
Mailing Address - Fax:
Practice Address - Street 1:835 S HIGHWAY 395
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2620
Practice Address - Country:US
Practice Address - Phone:541-567-7805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0015066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist