Provider Demographics
NPI:1124303433
Name:MANABAT, OMEED JONATHAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:OMEED
Middle Name:JONATHAN
Last Name:MANABAT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2010
Mailing Address - Country:US
Mailing Address - Phone:619-528-1793
Mailing Address - Fax:619-528-1797
Practice Address - Street 1:3222 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2010
Practice Address - Country:US
Practice Address - Phone:619-528-1793
Practice Address - Fax:619-528-1797
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64068183500000X
CT10792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist