Provider Demographics
NPI:1659104958
Name:MANCINI, JUSTIN M (PHARMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:MANCINI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E BALTIMORE AVE APT K6
Mailing Address - Street 2:
Mailing Address - City:CLIFTON HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1712
Mailing Address - Country:US
Mailing Address - Phone:717-343-5952
Mailing Address - Fax:
Practice Address - Street 1:1991 SPROUL RD STE 11
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4873
Practice Address - Country:US
Practice Address - Phone:610-356-6504
Practice Address - Fax:610-356-7319
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP458753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARPI016962OtherSTATE OF PENNSYLVANIS