Provider Demographics
NPI:1871960286
Name:MANESH, SOHAIL JACOB KHALIL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SOHAIL
Middle Name:JACOB KHALIL
Last Name:MANESH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JACOB
Other - Middle Name:
Other - Last Name:MANESH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1940 N HIGHLAND AVE APT 52
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3293
Mailing Address - Country:US
Mailing Address - Phone:818-470-4857
Mailing Address - Fax:
Practice Address - Street 1:1940 N HIGHLAND AVE APT 52
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-3293
Practice Address - Country:US
Practice Address - Phone:818-470-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist