Provider Demographics
NPI:1194092551
Name:MANEVAL, MARK STEVEN (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:MANEVAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 FRANCES DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2821
Mailing Address - Country:US
Mailing Address - Phone:443-621-8945
Mailing Address - Fax:
Practice Address - Street 1:1335 E WEST HWY
Practice Address - Street 2:SUITE 6-100
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3225
Practice Address - Country:US
Practice Address - Phone:301-295-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist