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General NPI Number Information
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NPI Number | 1730429077
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Entity Type | Individual
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Provider Name | DESIREE MANCE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/24/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 1201 COUNTY ROAD 581
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-9261
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Country | US
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Telephone | 813-907-6682
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Fax |
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Provider Business Mailing Address
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Address Line | 18110 SUGAR BROOKE DR
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City | TAMPA
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State | FL
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Zip | 33647-3131
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Country | US
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Telephone | 770-598-8431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS49904
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH019240
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License Number State | GA
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