Provider Demographics
NPI:1588955645
Name:MANN, PAUL L (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:MANN
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 1:453 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1646
Mailing Address - Country:US
Mailing Address - Phone:859-879-3784
Mailing Address - Fax:859-879-3882
Practice Address - Street 1:453 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1646
Practice Address - Country:US
Practice Address - Phone:859-879-3784
Practice Address - Fax:859-879-3882
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist