Provider Demographics
NPI:1629587464
Name:MANNING, ANASTASIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:MANNING
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 1:1343 N MARTEL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4808
Mailing Address - Country:US
Mailing Address - Phone:617-901-5550
Mailing Address - Fax:
Practice Address - Street 1:1343 N MARTEL AVE APT 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4808
Practice Address - Country:US
Practice Address - Phone:617-901-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA758451835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care