Provider Demographics
NPI:1508289893
Name:FADAKAR, MANDY (RPH)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:FADAKAR
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 1:700 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-2102
Mailing Address - Country:US
Mailing Address - Phone:610-387-2206
Mailing Address - Fax:610-387-2207
Practice Address - Street 1:700 EVERGREEN DRIVE
Practice Address - Street 2:
Practice Address - City:GLENN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342
Practice Address - Country:US
Practice Address - Phone:610-387-2206
Practice Address - Fax:610-387-2207
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist