Provider Demographics
NPI:1104864750
Name:MANKUTA, BARBARA W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:W
Last Name:MANKUTA
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 1:12712 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5406
Mailing Address - Country:US
Mailing Address - Phone:954-341-0599
Mailing Address - Fax:
Practice Address - Street 1:10214 USA TODAY WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3905
Practice Address - Country:US
Practice Address - Phone:800-526-1490
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27621183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist