Healthcare Provider Details

I. General information

NPI: 1891245130
Provider Name (Legal Business Name): JOHN MANESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN MANESS RPH

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

IV. Provider business mailing address

1800 KENNEDY DR
WICKLIFFE OH
44092-1616
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-3860
  • Fax: 216-283-3861
Mailing address:
  • Phone: 216-283-3860
  • Fax: 216-283-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number03315848
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: