Healthcare Provider Details

I. General information

NPI: 1104539964
Provider Name (Legal Business Name): NANCY MANDAIR PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12731 S SAGINAW ST
GRAND BLANC MI
48439-1830
US

IV. Provider business mailing address

6129 MAPLEBROOK LN
FLINT MI
48507-4148
US

V. Phone/Fax

Practice location:
  • Phone: 810-953-9156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302414174
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: