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NPI Code Detail

MEDICARE: RICHARD MANN R.PH.

MEDICARE: RICHARD MANN R.PH.
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
1183500000XPharmacist115864MN

General Provider Information

NPI Number : 1699092569
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD MANN R.PH.
Provider Business Mailing Address
First Line : 720 SNELLING AVE N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1844
Country : US
Telephone Number : 651-645-8636
Fax Number : 651-647-9730
Provider Business Practice Location Address
First Line : 720 SNELLING AVE N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-1844
Country : US
Telephone Number : 651-645-8636
Fax Number : 651-647-9730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2010
Last Update Date : 04/30/2010

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