Provider Demographics
NPI:1013704634
Name:MANASSE, JEAN GARRY (RPH)
Entity type:Individual
Prefix:
First Name:JEAN GARRY
Middle Name:
Last Name:MANASSE
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 STONE GLEN WAY APT 109
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1731
Mailing Address - Country:US
Mailing Address - Phone:561-293-9398
Mailing Address - Fax:
Practice Address - Street 1:7403 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9101
Practice Address - Country:US
Practice Address - Phone:407-677-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL68698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist