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General NPI Number Information
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NPI Number | 1598369738
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Entity Type | Individual
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Provider Name | MANASE STEPHEN MARIKI RPH
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Gender | Male
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Dates
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Enumeration Date | 11/29/2020
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 3065 N JOSEY LN
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City | CARROLLTON
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State | TX
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Zip | 75007-5340
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Country | US
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Telephone | 972-492-0425
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Fax |
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Provider Business Mailing Address
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Address Line | 740 RED FOX
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City | PROSPER
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State | TX
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Zip | 75078-5097
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Country | US
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Telephone | 214-677-6997
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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 | 44148
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License Number State | TX
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