Provider Demographics
NPI:1265657696
Name:MANNIS, WENDY (RPH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MANNIS
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 1:1333 IRIS AVENUE
Mailing Address - Street 2:IRIS PHARMACY
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304
Mailing Address - Country:US
Mailing Address - Phone:303-413-6288
Mailing Address - Fax:303-413-6291
Practice Address - Street 1:1333 IRIS AVE
Practice Address - Street 2:IRIS PHARMACY
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2226
Practice Address - Country:US
Practice Address - Phone:303-413-6288
Practice Address - Fax:303-413-6291
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist