Provider Demographics
NPI:1356678635
Name:MANOLAS, THEODORA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:
Last Name:MANOLAS
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 1:7421 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6339
Mailing Address - Country:US
Mailing Address - Phone:718-899-2600
Mailing Address - Fax:
Practice Address - Street 1:7421 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6339
Practice Address - Country:US
Practice Address - Phone:718-899-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-07
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046435183500000X
NJ28RI02678100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist