Christopher Sean Vanmanivong, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

051303431 Issued in IL

Practice address

6410 E State St
Rockford, IL 61108-3008

Phone

(815) 397-2127

NPI assigned

Feb 22, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1861086704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6428 WILLOWICK CT",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611081590",
            "telephone_number": "815-721-5206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611083008",
            "telephone_number": "815-397-2127"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6428 Willowick Ct",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611081590",
            "country_code": "US",
            "telephone_number": "815-721-5206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANMANIVONG",
        "first_name": "CHRISTOPHER",
        "middle_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-22",
        "last_updated": "2021-03-15",
        "certification_date": "2021-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "IL",
            "license": "051303431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evangeline Van Offeren
• Geoffrey S. Van Thiel, MD
• Mark Vananrooy, PA
• Allison Vander Heyden, MS, RD, LD, CD
• Aaron S Vanman, LCSW
• Marla Jo Vanvickle, APN
• Stacy A. Vanvleet, NP
• Varna Varghese
• David A. Varland, D.D.S.
• Patricia G. Varland, PT

• Pharmacist in Rockford, IL
• Providers in Rockford, IL by specialty
• Pharmacist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.