Provider Demographics
NPI:1275690851
Name:MANZANI, RONALD DENNIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DENNIS
Last Name:MANZANI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18688 HILLSBORO RD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3915
Mailing Address - Country:US
Mailing Address - Phone:818-366-3278
Mailing Address - Fax:
Practice Address - Street 1:9375 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1418
Practice Address - Country:US
Practice Address - Phone:818-768-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA406210Medicaid
CAPHA406210Medicaid