Provider Demographics
NPI:1740693860
Name:MANN, SUKHDEEP (RPH)
Entity type:Individual
Prefix:
First Name:SUKHDEEP
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 1:145 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1430
Mailing Address - Country:US
Mailing Address - Phone:419-683-2512
Mailing Address - Fax:419-683-6322
Practice Address - Street 1:145 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1430
Practice Address - Country:US
Practice Address - Phone:419-683-2512
Practice Address - Fax:419-683-6322
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03226475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist