Provider Demographics
NPI:1699221903
Name:MANAH, LAURA MOHAMAD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MOHAMAD
Last Name:MANAH
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 1:2546 EL SEGUNDO DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3404
Mailing Address - Country:US
Mailing Address - Phone:916-267-5652
Mailing Address - Fax:
Practice Address - Street 1:1125 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5286
Practice Address - Country:US
Practice Address - Phone:916-452-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist