Provider Demographics
NPI:1124858345
Name:DHAGE, MANMATH
Entity type:Individual
Prefix:
First Name:MANMATH
Middle Name:
Last Name:DHAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 ENGH RD STE A
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9627
Mailing Address - Country:US
Mailing Address - Phone:509-422-1500
Mailing Address - Fax:509-422-1514
Practice Address - Street 1:903 ENGH RD STE A
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9627
Practice Address - Country:US
Practice Address - Phone:509-422-1500
Practice Address - Fax:509-422-1514
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60662483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist