Provider Demographics
NPI:1700176526
Name:MANUTES, ROBERT C
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:MANUTES
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:C
Other - Last Name:MANUTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1834 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8086
Mailing Address - Country:US
Mailing Address - Phone:843-471-2948
Mailing Address - Fax:
Practice Address - Street 1:918 HOUSTON NORTHCUTT BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3770
Practice Address - Country:US
Practice Address - Phone:843-884-5144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist