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NPI Code Detail

MEDICARE: JADE MANANSALA PHARM.D.

MEDICARE: JADE MANANSALA PHARM.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist51971TX

General Provider Information

NPI Number : 1508113119
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADE MANANSALA PHARM.D.
Provider Business Mailing Address
First Line : 5200 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77056-5413
Country : US
Telephone Number : 713-623-0643
Fax Number : 713-623-0693
Provider Business Practice Location Address
First Line : 5200 WESTHEIMER RD
Second Line :
City : HOUSTON
State : TX
Zip : 77056-5413
Country : US
Telephone Number : 713-623-0643
Fax Number : 713-623-0693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2012
Last Update Date : 08/31/2012

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Directions to “ JADE MANANSALA PHARM.D.” Practice Location

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