Provider Demographics
NPI:1922637297
Name:MANNAA, HEBA
Entity Type:Individual
Prefix:
First Name:HEBA
Middle Name:
Last Name:MANNAA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 WINDFALL LN STE 90
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8027
Mailing Address - Country:US
Mailing Address - Phone:317-548-8015
Mailing Address - Fax:
Practice Address - Street 1:8411 WINDFALL LN STE 90
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8027
Practice Address - Country:US
Practice Address - Phone:317-548-8015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027578A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist