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NPI Code Detail

MEDICARE: BRITTANY BLISS MANNINEN RPH

MEDICARE: BRITTANY BLISS MANNINEN RPH
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
1183500000XPharmacist049496NY

General Provider Information

NPI Number : 1487976049
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY BLISS MANNINEN RPH
Provider Business Mailing Address
First Line : 11562B NORTHERN BLVD
Second Line :
City : FORT DRUM
State : NY
Zip : 13603-3509
Country : US
Telephone Number : 315-405-8373
Fax Number :
Provider Business Practice Location Address
First Line : 929 ARSENAL ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2305
Country : US
Telephone Number : 315-788-0309
Fax Number : 315-788-1702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2010
Last Update Date : 02/24/2010

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Directions to “ BRITTANY BLISS MANNINEN RPH” Practice Location

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