Provider Demographics
NPI:1891032959
Name:MANEE, ELISE N (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:N
Last Name:MANEE
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 1:13650 FIDDLESTICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-0312
Mailing Address - Country:US
Mailing Address - Phone:239-768-1413
Mailing Address - Fax:239-768-7396
Practice Address - Street 1:13650 FIDDLESTICKS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0312
Practice Address - Country:US
Practice Address - Phone:239-768-1413
Practice Address - Fax:239-768-7396
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist