Provider Demographics
NPI:1447426168
Name:MANNA, MOHAMMAD AHMAD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:AHMAD
Last Name:MANNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4944 W IRLO BRONSON MEMORIAL HWY
Mailing Address - Street 2:513
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-5337
Mailing Address - Country:US
Mailing Address - Phone:407-361-0744
Mailing Address - Fax:
Practice Address - Street 1:4944 W IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:513
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-5337
Practice Address - Country:US
Practice Address - Phone:407-361-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 31294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist