Healthcare Provider Details

I. General information

NPI: 1740614387
Provider Name (Legal Business Name): WHITNEY MANSY PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S HENDERSON ST
FORT WORTH TX
76104-1017
US

IV. Provider business mailing address

PO BOX 1194
BURLESON TX
76097-1194
US

V. Phone/Fax

Practice location:
  • Phone: 866-566-1548
  • Fax: 866-320-8853
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD13766
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69549
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: