Provider Demographics
NPI:1023218518
Name:MANN, LOLA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LOLA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1904
Mailing Address - Country:US
Mailing Address - Phone:773-631-5333
Mailing Address - Fax:773-763-1402
Practice Address - Street 1:7124 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1904
Practice Address - Country:US
Practice Address - Phone:773-631-5333
Practice Address - Fax:773-763-1402
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist