MEDICARE: DR. HENDRICK MANALO BS, PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	60273	CA

General Provider Information

NPI Number	:	1306033717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENDRICK MANALO BS, PHARMD

Provider Business Mailing Address
First Line	:	6753 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1218
Country	:	US
Telephone Number	:	267-872-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	6753 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-1218
Country	:	US
Telephone Number	:	323-957-2840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2007
Last Update Date	:	12/06/2012

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