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NPI Code Detail

MEDICARE: MANCHESTER UNIVERSITY COLLEGE OF PHARMACY

MEDICARE: MANCHESTER UNIVERSITY COLLEGE OF PHARMACY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center26023835AIN

General Provider Information

NPI Number : 1285010579
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANCHESTER UNIVERSITY COLLEGE OF PHARMACY
Provider Business Mailing Address
First Line : 10627 DIEBOLD RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-8606
Country : US
Telephone Number : 260-470-2664
Fax Number :
Provider Business Practice Location Address
First Line : 10627 DIEBOLD RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-8606
Country : US
Telephone Number : 260-470-2664
Fax Number :
Authorized Official
Title or Position : AMBULATORY CARE SPECIALIST
Name : ANDREA WILHITE
Credential : PHARMD
Telephone Number : 260-470-2664
Provider Enumeration Date : 08/10/2015
Last Update Date : 08/10/2015

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Directions to “MANCHESTER UNIVERSITY COLLEGE OF PHARMACY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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