Provider Demographics
NPI:1720416027
Name:MANNA, JAMIL (RPH)
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:
Last Name:MANNA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4513
Mailing Address - Country:US
Mailing Address - Phone:703-215-8000
Mailing Address - Fax:703-955-7558
Practice Address - Street 1:1890 METRO CENTER DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5286
Practice Address - Country:US
Practice Address - Phone:703-709-1560
Practice Address - Fax:703-709-1645
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist