Provider Demographics
NPI:1518286780
Name:MUSALE, MANOJ
Entity Type:Individual
Prefix:MR
First Name:MANOJ
Middle Name:
Last Name:MUSALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 US HIGHWAY 98 N
Mailing Address - Street 2:WALGREENS
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-0402
Mailing Address - Country:US
Mailing Address - Phone:863-815-2343
Mailing Address - Fax:863-859-9190
Practice Address - Street 1:4445 US HIGHWAY 98 N
Practice Address - Street 2:WALGREENS
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-0402
Practice Address - Country:US
Practice Address - Phone:863-815-2343
Practice Address - Fax:863-859-9190
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 33242183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist