Provider Demographics
NPI:1598369738
Name:MARIKI, MANASE STEPHEN (RPH)
Entity Type:Individual
Prefix:
First Name:MANASE
Middle Name:STEPHEN
Last Name:MARIKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:MANASE
Other - Last Name:MARIKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:740 RED FOX
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5097
Mailing Address - Country:US
Mailing Address - Phone:214-677-6997
Mailing Address - Fax:
Practice Address - Street 1:3065 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5340
Practice Address - Country:US
Practice Address - Phone:972-492-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist