Provider Demographics
NPI:1669705075
Name:MANN, FREDA HOWELL (RPH)
Entity type:Individual
Prefix:MS
First Name:FREDA
Middle Name:HOWELL
Last Name:MANN
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 1:12525 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5617
Mailing Address - Country:US
Mailing Address - Phone:503-646-3438
Mailing Address - Fax:503-626-0239
Practice Address - Street 1:12525 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5617
Practice Address - Country:US
Practice Address - Phone:503-646-3438
Practice Address - Fax:503-626-0239
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0007290OtherSTATE OF OREGON BOARD OF PHARMACY