Provider Demographics
NPI:1285948190
Name:MANN, DUSTIN MICHAEL (CPHT)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:MANN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 IH 10 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1014
Mailing Address - Country:US
Mailing Address - Phone:210-558-3027
Mailing Address - Fax:210-558-6013
Practice Address - Street 1:12777 IH 10 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1014
Practice Address - Country:US
Practice Address - Phone:210-558-3027
Practice Address - Fax:210-558-6013
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142022183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician