Provider Demographics
NPI:1710490701
Name:MANN, DENZEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENZEL
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:KOTZEBUE
Mailing Address - State:AK
Mailing Address - Zip Code:99752-0649
Mailing Address - Country:US
Mailing Address - Phone:757-254-4481
Mailing Address - Fax:
Practice Address - Street 1:436 5TH AVENUE
Practice Address - Street 2:MANIILAQ HEALTH CENTER
Practice Address - City:KOTZEBUE
Practice Address - State:AK
Practice Address - Zip Code:99752-9975
Practice Address - Country:US
Practice Address - Phone:757-254-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist