Provider Demographics
NPI:1083939961
Name:MANDERS, BREANNA MANDERS M (PHARMD)
Entity Type:Individual
Prefix:
First Name:BREANNA MANDERS
Middle Name:M
Last Name:MANDERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1612
Mailing Address - Country:US
Mailing Address - Phone:319-351-3880
Mailing Address - Fax:319-466-9167
Practice Address - Street 1:1914 8TH ST
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1612
Practice Address - Country:US
Practice Address - Phone:319-351-3880
Practice Address - Fax:319-466-9167
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist