Provider Demographics
NPI:1114598307
Name:MANCHESTER, ROBERT (CPHT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MANCHESTER
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8719 MEADOWBROOK DR APT 11
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2901
Mailing Address - Country:US
Mailing Address - Phone:989-746-4799
Mailing Address - Fax:
Practice Address - Street 1:8701 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2904
Practice Address - Country:US
Practice Address - Phone:810-220-5840
Practice Address - Fax:810-220-0283
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303014843183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician