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General NPI Number Information
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NPI Number | 1225631260
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Entity Type | Individual
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Provider Name | FREDRICK NZAI MANASSEH PHARM.D, MBA,BCGP
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Gender | Male
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Dates
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Enumeration Date | 11/20/2020
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 1 CONCOURSE PKWY STE 700
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City | ATLANTA
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State | GA
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Zip | 30328-6128
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Country | US
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Telephone | 316-841-5444
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Fax |
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Provider Business Mailing Address
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Address Line | 400 W PEACHTREE ST NW UNIT 2713
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City | ATLANTA
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State | GA
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Zip | 30308-3554
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Country | US
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Telephone | 316-841-5444
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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 | 55015
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2007019773
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03232571
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License Number State | OH
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