Provider Demographics
NPI:1063126688
Name:MANN, TERRENCE CHRISTOPHER (PHARMD)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:CHRISTOPHER
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 1:300 POWDER SPRINGS ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-3452
Mailing Address - Country:US
Mailing Address - Phone:770-422-1413
Mailing Address - Fax:
Practice Address - Street 1:300 POWDER SPRINGS ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3452
Practice Address - Country:US
Practice Address - Phone:770-422-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty