Provider Demographics
NPI:1326183898
Name:MANFY INC
Entity Type:Organization
Organization Name:MANFY INC
Other - Org Name:MEDICINE SHOPPE #1864
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-457-7539
Mailing Address - Street 1:2303 W 15TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1500
Mailing Address - Country:US
Mailing Address - Phone:850-785-0700
Mailing Address - Fax:850-785-0747
Practice Address - Street 1:2303 W 15TH ST STE D
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1500
Practice Address - Country:US
Practice Address - Phone:850-785-0700
Practice Address - Fax:850-785-0747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH242353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1014517OtherNCPDP PROVIDER IDENTIFICATION NUMBER