Provider Demographics
NPI:1275148629
Name:MANZANERO, LUCY JACQUELINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:JACQUELINE
Last Name:MANZANERO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2520
Mailing Address - Country:US
Mailing Address - Phone:209-613-1590
Mailing Address - Fax:
Practice Address - Street 1:16858 GOLDEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-9240
Practice Address - Country:US
Practice Address - Phone:209-242-5042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist