Provider Demographics
NPI:1487370961
Name:MANIAR, DEANNA IVA
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:IVA
Last Name:MANIAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 BLISS PT E
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-4422
Mailing Address - Country:US
Mailing Address - Phone:732-580-6783
Mailing Address - Fax:
Practice Address - Street 1:265 S SCATTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-5106
Practice Address - Country:US
Practice Address - Phone:765-643-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023851A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist