Provider Demographics
NPI:1497878433
Name:MANN, PENNY ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:ANNE
Last Name:MANN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3823 PROVENCAL DR
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-8705
Mailing Address - Country:US
Mailing Address - Phone:517-543-0830
Mailing Address - Fax:517-543-9087
Practice Address - Street 1:201 S COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1550
Practice Address - Country:US
Practice Address - Phone:517-543-0830
Practice Address - Fax:517-543-9087
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist