Provider Demographics
NPI:1609030055
Name:MANCHENO, CARLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:MANCHENO
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 1:114 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-3506
Mailing Address - Country:US
Mailing Address - Phone:973-568-3144
Mailing Address - Fax:
Practice Address - Street 1:651 N STILES ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5759
Practice Address - Country:US
Practice Address - Phone:908-486-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03214800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist