Provider Demographics
NPI:1306338868
Name:MANHATTAN VILLAGE PHARMACY INC.
Entity type:Organization
Organization Name:MANHATTAN VILLAGE PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDERSON
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PH00019615
Authorized Official - Phone:425-251-6335
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-0479
Mailing Address - Country:US
Mailing Address - Phone:425-251-6335
Mailing Address - Fax:425-251-6337
Practice Address - Street 1:10102 E KNOX AVE STE 400
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4146
Practice Address - Country:US
Practice Address - Phone:425-251-6335
Practice Address - Fax:425-251-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy