Provider Demographics
NPI:1467709386
Name:MANUEL, JULIANNE ANNETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIANNE
Middle Name:ANNETTE
Last Name:MANUEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62664-1403
Mailing Address - Country:US
Mailing Address - Phone:217-482-5985
Mailing Address - Fax:217-482-5715
Practice Address - Street 1:149 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IL
Practice Address - Zip Code:62664-1403
Practice Address - Country:US
Practice Address - Phone:217-482-5985
Practice Address - Fax:309-291-0181
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist