Provider Demographics
NPI:1932599446
Name:MANCINI, NICHOALS (MS, RPH)
Entity Type:Individual
Prefix:MR
First Name:NICHOALS
Middle Name:
Last Name:MANCINI
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1607
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34430-1607
Mailing Address - Country:US
Mailing Address - Phone:352-489-0822
Mailing Address - Fax:
Practice Address - Street 1:10051 S US HIGHWAY 41
Practice Address - Street 2:C/O WINN-DIXIE PHARMACY
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-4190
Practice Address - Country:US
Practice Address - Phone:352-465-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13299183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy