Provider Demographics
NPI:1962927822
Name:MANRRIQUE, JOEL DAVID (RPH)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:DAVID
Last Name:MANRRIQUE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 AVENS ARBOR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5281
Mailing Address - Country:US
Mailing Address - Phone:956-566-3170
Mailing Address - Fax:
Practice Address - Street 1:6818 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1136
Practice Address - Country:US
Practice Address - Phone:210-927-4596
Practice Address - Fax:210-923-4869
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist