Provider Demographics
NPI:1508188392
Name:MANTELL, CAROLE HEIDI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:HEIDI
Last Name:MANTELL
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 1:75 NASSAU TERMINAL RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4927
Mailing Address - Country:US
Mailing Address - Phone:516-280-1000
Mailing Address - Fax:516-280-1074
Practice Address - Street 1:75 NASSAU TERMINAL RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4927
Practice Address - Country:US
Practice Address - Phone:516-280-1000
Practice Address - Fax:516-280-1074
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist