Provider Demographics
NPI:1255657920
Name:MANVEL PHARMACY
Entity Type:Organization
Organization Name:MANVEL PHARMACY
Other - Org Name:MANVEL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGWAFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-489-3210
Mailing Address - Street 1:20226 HIGHWAY 6
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3850
Mailing Address - Country:US
Mailing Address - Phone:281-489-3210
Mailing Address - Fax:281-489-3834
Practice Address - Street 1:20226 HIGHWAY 6 STE C
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3850
Practice Address - Country:US
Practice Address - Phone:281-489-3210
Practice Address - Fax:281-489-3834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX268933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4555376OtherNCPDP PROVIDER IDENTIFICATION NUMBER