Provider Demographics
NPI:1366812323
Name:MANOHAR, JESSICA HYCINTH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:HYCINTH
Last Name:MANOHAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16421 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1241
Mailing Address - Country:US
Mailing Address - Phone:917-853-5658
Mailing Address - Fax:
Practice Address - Street 1:2312 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2029
Practice Address - Country:US
Practice Address - Phone:516-735-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist