Individual
SALLY MANIBUSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 GEARY ST SE, ALBANY, OR 97322-6842
(541) 812-5533
Mailing address
1333 CLAY ST SE, ALBANY, OR 97322-6868
(541) 924-9598
(541) 967-8346
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
RPH-0013841
OR
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH-0013841
OR
Other
Enumeration date
10/30/2013
Last updated
09/25/2019
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