Provider Demographics
NPI:1003387457
Name:MANSY, MEDHAT N (RPH)
Entity Type:Individual
Prefix:
First Name:MEDHAT
Middle Name:N
Last Name:MANSY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 PERCHING BIRD LN
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2358
Mailing Address - Country:US
Mailing Address - Phone:725-465-7770
Mailing Address - Fax:725-465-7771
Practice Address - Street 1:821 N LAMB BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5439
Practice Address - Country:US
Practice Address - Phone:725-465-7770
Practice Address - Fax:725-465-7771
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist