Provider Demographics
NPI:1215346226
Name:MANNING, JEFFERY CLARK (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:CLARK
Last Name:MANNING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 E RODEO DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-5999
Mailing Address - Country:US
Mailing Address - Phone:928-634-0440
Mailing Address - Fax:928-634-0420
Practice Address - Street 1:2003 E RODEO DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-5999
Practice Address - Country:US
Practice Address - Phone:928-634-0440
Practice Address - Fax:928-634-0420
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist