Provider Demographics
NPI:1235411588
Name:MANN, FRED H (RPH)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:H
Last Name:MANN
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 1:42010 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203
Mailing Address - Country:US
Mailing Address - Phone:760-772-9122
Mailing Address - Fax:760-345-5089
Practice Address - Street 1:42010 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9610
Practice Address - Country:US
Practice Address - Phone:760-772-9122
Practice Address - Fax:760-345-5089
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35827183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist