Provider Demographics
NPI:1356893044
Name:MANCELL, JOHN (PHARM D)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MANCELL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CARL PERKINS PKWY
Mailing Address - Street 2:
Mailing Address - City:TIPTONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38079-1678
Mailing Address - Country:US
Mailing Address - Phone:731-253-0153
Mailing Address - Fax:731-253-0143
Practice Address - Street 1:650 CARL PERKINS PKWY
Practice Address - Street 2:
Practice Address - City:TIPTONVILLE
Practice Address - State:TN
Practice Address - Zip Code:38079
Practice Address - Country:US
Practice Address - Phone:731-253-0153
Practice Address - Fax:731-253-0143
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist