Provider Demographics
NPI:1427265404
Name:MANTEY, CHARLES (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:MANTEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8827 LIBERTY ST.
Mailing Address - Street 2:
Mailing Address - City:PORT AUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:48467
Mailing Address - Country:US
Mailing Address - Phone:989-269-9024
Mailing Address - Fax:989-453-4465
Practice Address - Street 1:8827 LIBERTY ST.
Practice Address - Street 2:
Practice Address - City:PORT AUSTIN
Practice Address - State:MI
Practice Address - Zip Code:48467
Practice Address - Country:US
Practice Address - Phone:989-269-9024
Practice Address - Fax:989-453-4465
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023331183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy