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General NPI Number Information
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NPI Number | 1205796430
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Entity Type | Individual
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Provider Name | JESSICA GRACE MANALANG
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Gender |
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Dates
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Enumeration Date | 11/11/2025
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 5713 N PERSHING AVE STE A3
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City | STOCKTON
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State | CA
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Zip | 95207-4910
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Country | US
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Telephone | 209-488-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 9804 CARICO WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-6389
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 91595
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License Number State | CA
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