Provider Demographics
NPI:1821479668
Name:MANASCO, COURTNEY CAMPBELL (RPH)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CAMPBELL
Last Name:MANASCO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3313 ESSEX DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082
Mailing Address - Country:US
Mailing Address - Phone:214-765-5458
Mailing Address - Fax:214-765-5477
Practice Address - Street 1:3313 ESSEX DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082
Practice Address - Country:US
Practice Address - Phone:214-765-5458
Practice Address - Fax:214-765-5477
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist