Provider Demographics
NPI:1912310798
Name:MANOS, CRISTINA (RPH)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:MANOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 E BERMUDA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1809
Mailing Address - Country:US
Mailing Address - Phone:520-668-3079
Mailing Address - Fax:
Practice Address - Street 1:4040 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-2720
Practice Address - Country:US
Practice Address - Phone:520-202-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist