Provider Demographics
NPI:1548546930
Name:MANUEL, DAVINA D (RPH)
Entity type:Individual
Prefix:MRS
First Name:DAVINA
Middle Name:D
Last Name:MANUEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MAYODAN
Mailing Address - State:NC
Mailing Address - Zip Code:27027-2804
Mailing Address - Country:US
Mailing Address - Phone:336-548-6337
Mailing Address - Fax:336-548-0012
Practice Address - Street 1:400 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:MAYODAN
Practice Address - State:NC
Practice Address - Zip Code:27027
Practice Address - Country:US
Practice Address - Phone:336-548-6337
Practice Address - Fax:336-548-0012
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist