Provider Demographics
NPI:1922181379
Name:MANZI, BRIAN JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JAMES
Last Name:MANZI
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 1:146 BIRCHWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-4708
Mailing Address - Country:US
Mailing Address - Phone:724-864-3421
Mailing Address - Fax:
Practice Address - Street 1:235 5TH ST
Practice Address - Street 2:FREEPORT PHARMACY
Practice Address - City:FREEPORT
Practice Address - State:PA
Practice Address - Zip Code:16229-1246
Practice Address - Country:US
Practice Address - Phone:724-295-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437962183500000X
TX40189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP437962OtherPHARMACIST LICENSE