Provider Demographics
NPI:1669754834
Name:MANOCCHIO, JONATHAN ROSS (PHARM D, BCPS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ROSS
Last Name:MANOCCHIO
Suffix:
Gender:M
Credentials:PHARM D, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 W 9TH ST
Mailing Address - Street 2:APARTMENT 735
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1028
Mailing Address - Country:US
Mailing Address - Phone:440-537-9559
Mailing Address - Fax:
Practice Address - Street 1:18901 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1078
Practice Address - Country:US
Practice Address - Phone:216-692-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03330838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist