Provider Demographics
NPI:1417195371
Name:MANNO, NICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NICK
Middle Name:
Last Name:MANNO
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 1:442 97TH ST
Mailing Address - Street 2:APT 1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7465
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:442 97TH ST
Practice Address - Street 2:APT 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7465
Practice Address - Country:US
Practice Address - Phone:718-238-4109
Practice Address - Fax:718-238-4109
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0438751835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist