Provider Demographics
NPI:1659316206
Name:MANCINI, CARL MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:MICHAEL
Last Name:MANCINI
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 1:83 TAFT PT
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-5902
Mailing Address - Country:US
Mailing Address - Phone:203-757-9556
Mailing Address - Fax:
Practice Address - Street 1:1 FAR MILL XING
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6121
Practice Address - Country:US
Practice Address - Phone:203-225-8614
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist