Provider Demographics
NPI:1477858173
Name:MANCUSO, DAVID B (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 NW 50TH DR APT 5108
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-4588
Mailing Address - Country:US
Mailing Address - Phone:352-219-1591
Mailing Address - Fax:
Practice Address - Street 1:4170 NW 50TH DR APT 5108
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4588
Practice Address - Country:US
Practice Address - Phone:352-219-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist