Provider Demographics
NPI:1538418959
Name:MANZANO, ERIC (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MANZANO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:ERIC
Other - Last Name:MANZANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:55 MAHOGANY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3466
Mailing Address - Country:US
Mailing Address - Phone:415-802-6777
Mailing Address - Fax:
Practice Address - Street 1:1001 METRO CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2177
Practice Address - Country:US
Practice Address - Phone:650-286-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist