Healthcare Provider Details

I. General information

NPI: 1376383364
Provider Name (Legal Business Name): NIEL CARLO MANIAGO CONCEPCION PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 E BUENA VISTA AVE
DEDEDO GU
96929-5373
US

IV. Provider business mailing address

PO BOX 23281
BARRIGADA GU
96921-3281
US

V. Phone/Fax

Practice location:
  • Phone: 671-637-9683
  • Fax: 671-637-3408
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH0581
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: