Provider Demographics
NPI:1750676300
Name:MANIGO, JACQUETTA LASHEA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUETTA
Middle Name:LASHEA
Last Name:MANIGO
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 1:1907 E VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-3714
Mailing Address - Country:US
Mailing Address - Phone:912-644-1601
Mailing Address - Fax:
Practice Address - Street 1:1907 E VICTORY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3714
Practice Address - Country:US
Practice Address - Phone:912-644-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023984183500000X
SC11822183500000X
NC20248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist