Healthcare Provider Details

I. General information

NPI: 1285891614
Provider Name (Legal Business Name): JARROD MANN PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAJO ROUTE 7 & NAVAJO ROUTE 12
FORT DEFIANCE AZ
86504-0649
US

IV. Provider business mailing address

PO BOX 649 CORNER OF NR7 & NR12
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8328
  • Fax:
Mailing address:
  • Phone: 928-729-8328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number018272
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: