Provider Demographics
NPI:1285010579
Name:MANCHESTER UNIVERSITY COLLEGE OF PHARMACY
Entity Type:Organization
Organization Name:MANCHESTER UNIVERSITY COLLEGE OF PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULATORY CARE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:260-470-2664
Mailing Address - Street 1:10627 DIEBOLD RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8606
Mailing Address - Country:US
Mailing Address - Phone:260-470-2664
Mailing Address - Fax:
Practice Address - Street 1:10627 DIEBOLD RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8606
Practice Address - Country:US
Practice Address - Phone:260-470-2664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023835A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care