Provider Demographics
NPI:1891286985
Name:MANTZ, JACOB MCKAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:MCKAY
Last Name:MANTZ
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 1:705 GULF PEARL DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-0968
Mailing Address - Country:US
Mailing Address - Phone:702-630-4595
Mailing Address - Fax:
Practice Address - Street 1:501 S RANCHO DR STE G46
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4835
Practice Address - Country:US
Practice Address - Phone:702-912-4844
Practice Address - Fax:702-912-4846
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist