Provider Demographics
NPI:1487976049
Name:MANNINEN, BRITTANY BLISS (RPH)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:BLISS
Last Name:MANNINEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11562B NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603-3509
Mailing Address - Country:US
Mailing Address - Phone:315-405-8373
Mailing Address - Fax:
Practice Address - Street 1:929 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2305
Practice Address - Country:US
Practice Address - Phone:315-788-0309
Practice Address - Fax:315-788-1702
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist