=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922525351
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY MANZOLINE PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2017
-----------------------------------------------------
Last Update Date | 08/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9009 N 67TH AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85302-3991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-931-5169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35393 S PINNACLE PL
-----------------------------------------------------
City | BLACK CANYON CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85324-9200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-698-7243
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S022817
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------