Provider Demographics
NPI:1912662461
Name:MANN, RONALD D (PHARMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:MANN
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 1:770 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2056
Mailing Address - Country:US
Mailing Address - Phone:260-451-8242
Mailing Address - Fax:260-451-8247
Practice Address - Street 1:770 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2056
Practice Address - Country:US
Practice Address - Phone:260-451-8242
Practice Address - Fax:260-451-8247
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029341A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist