Provider Demographics
NPI:1467688200
Name:MANN, REBECCA P (PHARMD, BCPS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:P
Last Name:MANN
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRASTOW DR
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-1537
Mailing Address - Country:US
Mailing Address - Phone:857-234-2386
Mailing Address - Fax:
Practice Address - Street 1:1177 PROVIDENCE HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-0206
Practice Address - Country:US
Practice Address - Phone:617-972-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist