Provider Demographics
NPI:1326065806
Name:MANTEL, STEVEN J (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:MANTEL
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 1:324 DUBLIN LN
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-9135
Mailing Address - Country:US
Mailing Address - Phone:419-636-3493
Mailing Address - Fax:419-636-8001
Practice Address - Street 1:324 DUBLIN LN
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-9135
Practice Address - Country:US
Practice Address - Phone:419-636-3493
Practice Address - Fax:419-636-8001
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03309589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03309589OtherREGISTERED PHARMACIST