Provider Demographics
NPI:1306146477
Name:MANAHLE, ANTENEH (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ANTENEH
Middle Name:
Last Name:MANAHLE
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 1:5980 KINGSTOWNE TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5876
Mailing Address - Country:US
Mailing Address - Phone:703-921-3127
Mailing Address - Fax:703-921-3131
Practice Address - Street 1:5980 KINGSTOWNE TOWNE CTR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5876
Practice Address - Country:US
Practice Address - Phone:703-921-3127
Practice Address - Fax:703-921-3131
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207751183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist