Provider Demographics
NPI:1427184456
Name:MOCK, MANDY LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:LEE
Last Name:MOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:LEE
Other - Last Name:STACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 CENTER ST
Mailing Address - Street 2:THE MEDICAL CENTER DEPARTMENT OF PHARMACY
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1527
Mailing Address - Country:US
Mailing Address - Phone:706-571-4495
Mailing Address - Fax:706-571-1861
Practice Address - Street 1:710 CENTER ST
Practice Address - Street 2:THE MEDICAL CENTER DEPARTMENT OF PHARMACY
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1527
Practice Address - Country:US
Practice Address - Phone:706-571-4495
Practice Address - Fax:706-571-1861
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022373183500000X
AL14816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist