Provider Demographics
NPI:1215138722
Name:MANIAOL, MARLYN (RPH)
Entity type:Individual
Prefix:
First Name:MARLYN
Middle Name:
Last Name:MANIAOL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 ARROW RTE
Mailing Address - Street 2:STE K BLDG #3
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4552
Mailing Address - Country:US
Mailing Address - Phone:909-262-1287
Mailing Address - Fax:
Practice Address - Street 1:9613 ARROW RTE
Practice Address - Street 2:STE K BLDG #3
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4552
Practice Address - Country:US
Practice Address - Phone:909-262-1287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48361OtherPHARMACY LICENSE