Provider Demographics
NPI:1982208260
Name:MANSHIP, PHILLIP (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:MANSHIP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10911 RUNNING TIDE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8426
Mailing Address - Country:US
Mailing Address - Phone:317-694-1882
Mailing Address - Fax:
Practice Address - Street 1:10911 RUNNING TIDE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8426
Practice Address - Country:US
Practice Address - Phone:317-694-1882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013142A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist