Provider Demographics
NPI:1780681676
Name:MANNS DRUG STORE
Entity Type:Organization
Organization Name:MANNS DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MANNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-672-7617
Mailing Address - Street 1:1101 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-1301
Mailing Address - Country:US
Mailing Address - Phone:412-672-7617
Mailing Address - Fax:412-672-6770
Practice Address - Street 1:1101 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-1301
Practice Address - Country:US
Practice Address - Phone:412-672-7617
Practice Address - Fax:412-672-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006971000001Medicaid
1120310001Medicare ID - Type Unspecified