Provider Demographics
NPI:1477837664
Name:MANOS, PAMELA MARIE (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MARIE
Last Name:MANOS
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 1:5301 GREY STAG CT
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4155
Mailing Address - Country:US
Mailing Address - Phone:678-662-5164
Mailing Address - Fax:770-831-4697
Practice Address - Street 1:5301 GREY STAG CT
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4155
Practice Address - Country:US
Practice Address - Phone:678-662-5164
Practice Address - Fax:770-831-4697
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist