Provider Demographics
NPI:1942501986
Name:MANSON, ANITA LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LYNN
Last Name:MANSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 W AHLDAG ST
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-2410
Mailing Address - Country:US
Mailing Address - Phone:979-282-2201
Mailing Address - Fax:979-282-2202
Practice Address - Street 1:214 W AHLDAG ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-2410
Practice Address - Country:US
Practice Address - Phone:979-282-2201
Practice Address - Fax:979-282-2202
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist