Provider Demographics
NPI:1477882801
Name:MANNINO, GINA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:MANNINO
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 1:919 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8582
Mailing Address - Country:US
Mailing Address - Phone:816-682-3810
Mailing Address - Fax:
Practice Address - Street 1:1015 NE RICE RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-6360
Practice Address - Country:US
Practice Address - Phone:816-525-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001006696183500000X
KS1-12894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist