Provider Demographics
NPI:1669174546
Name:MANNING, PADEN RYAN
Entity type:Individual
Prefix:
First Name:PADEN
Middle Name:RYAN
Last Name:MANNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4830 J ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3742
Mailing Address - Country:US
Mailing Address - Phone:916-451-2187
Mailing Address - Fax:916-451-2192
Practice Address - Street 1:4830 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3742
Practice Address - Country:US
Practice Address - Phone:916-451-2187
Practice Address - Fax:916-451-2192
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173645183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician