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General NPI Number Information
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NPI Number | 1972120848
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Entity Type | Individual
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Provider Name | JUSTIN MANNERS PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 3825 CARPENTER RD
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City | YPSILANTI
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State | MI
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Zip | 48197-9606
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Country | US
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Telephone | 734-973-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 6944 JOY RD
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City | DEXTER
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State | MI
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Zip | 48130-9455
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Country | US
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Telephone | 734-476-5493
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 5302411810
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License Number State | MI
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