Provider Demographics
NPI:1184877805
Name:MANN, DAVID (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:MANN
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 1:7720 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3818
Mailing Address - Country:US
Mailing Address - Phone:215-342-1091
Mailing Address - Fax:
Practice Address - Street 1:7720 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3818
Practice Address - Country:US
Practice Address - Phone:153-421-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037118L183500000X
NY049468-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist