Provider Demographics
NPI:1518574870
Name:MANALO, VINCENT RAPHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:RAPHAEL
Last Name:MANALO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33527 STEPHANO CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2031
Mailing Address - Country:US
Mailing Address - Phone:510-301-6765
Mailing Address - Fax:
Practice Address - Street 1:3475 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-2233
Practice Address - Country:US
Practice Address - Phone:408-272-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist