Provider Demographics
NPI:1437863107
Name:MANSARAY, BRIMA
Entity Type:Individual
Prefix:
First Name:BRIMA
Middle Name:
Last Name:MANSARAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8085 ORANGE STATION LOOP
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7288
Mailing Address - Country:US
Mailing Address - Phone:614-516-8837
Mailing Address - Fax:
Practice Address - Street 1:6078 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1002
Practice Address - Country:US
Practice Address - Phone:614-396-9722
Practice Address - Fax:614-396-9799
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03228333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist