Provider Demographics
NPI:1538481296
Name:MANE, MOHAN DINKAR (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MOHAN
Middle Name:DINKAR
Last Name:MANE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 169TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3248
Mailing Address - Country:US
Mailing Address - Phone:718-359-2463
Mailing Address - Fax:
Practice Address - Street 1:1891 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3290
Practice Address - Country:US
Practice Address - Phone:718-346-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist