Provider Demographics
NPI:1124332663
Name:MANDES, KAROLINA ANNA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:KAROLINA
Middle Name:ANNA
Last Name:MANDES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 STARLING DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2779
Mailing Address - Country:US
Mailing Address - Phone:401-450-4415
Mailing Address - Fax:
Practice Address - Street 1:302 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-1535
Practice Address - Country:US
Practice Address - Phone:207-827-8021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist