Provider Demographics
NPI:1972871457
Name:MANUEL, JOHN WALTER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WALTER
Last Name:MANUEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3474 PENDULUM DR E
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-8395
Mailing Address - Country:US
Mailing Address - Phone:901-603-8155
Mailing Address - Fax:
Practice Address - Street 1:3474 PENDULUM DR E
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-8395
Practice Address - Country:US
Practice Address - Phone:901-603-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist