Provider Demographics
NPI:1629791074
Name:MANTEY, GODFRED (RPH)
Entity Type:Individual
Prefix:
First Name:GODFRED
Middle Name:
Last Name:MANTEY
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 1:9463 CHARDON CIR APT 304
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2999
Mailing Address - Country:US
Mailing Address - Phone:513-609-9523
Mailing Address - Fax:
Practice Address - Street 1:7217 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1547
Practice Address - Country:US
Practice Address - Phone:513-759-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03440896183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist