Provider Demographics
NPI:1770779639
Name:MANWARING, PAMELA GRACE (RPH, FASCP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:GRACE
Last Name:MANWARING
Suffix:
Gender:F
Credentials:RPH, FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1914
Mailing Address - Country:US
Mailing Address - Phone:415-457-3127
Mailing Address - Fax:
Practice Address - Street 1:33 VALLEY RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1914
Practice Address - Country:US
Practice Address - Phone:415-457-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493851835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy