Provider Demographics
NPI:1205136116
Name:MANDZAK, REBECCA ANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANN
Last Name:MANDZAK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 ROTUNDA DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3984
Mailing Address - Country:US
Mailing Address - Phone:313-633-2658
Mailing Address - Fax:
Practice Address - Street 1:18001 ROTUNDA DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3984
Practice Address - Country:US
Practice Address - Phone:313-633-2658
Practice Address - Fax:313-633-2659
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH63868183500000X
MI5302040805183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist