Provider Demographics
NPI:1861135998
Name:MANN, DALJIT S (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DALJIT
Middle Name:S
Last Name:MANN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 ASTER LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1035
Mailing Address - Country:US
Mailing Address - Phone:469-348-1418
Mailing Address - Fax:
Practice Address - Street 1:114 ASTER LN
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-1035
Practice Address - Country:US
Practice Address - Phone:469-348-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-17
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist