Provider Demographics
NPI:1356319677
Name:MANNO, JOSEPH EDWARD
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:MANNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 VICTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-1544
Mailing Address - Country:US
Mailing Address - Phone:757-727-1172
Mailing Address - Fax:757-727-1185
Practice Address - Street 1:3130 VICTORIA BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-1544
Practice Address - Country:US
Practice Address - Phone:757-727-1172
Practice Address - Fax:757-727-1185
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist