Provider Demographics
NPI:1275139172
Name:MANNING, JEREMIAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:MANNING
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 1:23 PENDER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03261-3350
Mailing Address - Country:US
Mailing Address - Phone:508-330-6909
Mailing Address - Fax:
Practice Address - Street 1:174 1ST NH TPKE
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261-3400
Practice Address - Country:US
Practice Address - Phone:603-942-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR27888183500000X
NHR2774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty