Individual
DR. SARA JEAN MANTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-7227
Mailing address
2313 E 17TH ST, FARMINGTON, NM 87401-7528
(724) 630-3881
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP0010144
WV
Other
Enumeration date
03/08/2018
Last updated
03/08/2018
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