Provider Demographics
NPI:1720776784
Name:MANESIS, ANASTASIA ELENI (PHARM D)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:ELENI
Last Name:MANESIS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 STADIUM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1211
Mailing Address - Country:US
Mailing Address - Phone:718-877-2894
Mailing Address - Fax:
Practice Address - Street 1:14208 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-1143
Practice Address - Country:US
Practice Address - Phone:917-444-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist