Active NPI
Wana Manitpisitkul, PHARM.D.
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Ellicott City, MD
National Provider Identifier
1700176872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 17787
- Practice address
- 4960 Walking Stick Rd
Apt H
Ellicott City, MD 21043-8058 - Phone
- (410) 328-9701
- NPI assigned
- Apr 11, 2011
- Last updated
- Apr 11, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 17787 | MD | Primary |
Addresses
Primary practice location
4960 Walking Stick Rd
Apt H
Ellicott City, MD 21043-8058
Mailing address
4960 Walking Stick Rd
Apt H
Ellicott City, MD 21043-8058
Phone (410) 328-9701
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17787 | MD | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302480000000",
"number": "1700176872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4960 WALKING STICK RD",
"address_2": "APT H",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210438058",
"telephone_number": "410-328-9701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4960 WALKING STICK RD",
"address_2": "APT H",
"city": "ELLICOTT CITY",
"state": "MD",
"postal_code": "210438058",
"telephone_number": "410-328-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANITPISITKUL",
"first_name": "WANA",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-11",
"last_updated": "2011-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MD",
"license": "17787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellicott City, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.