Provider Demographics
NPI:1043010457
Name:MANN, AVJOT
Entity type:Individual
Prefix:
First Name:AVJOT
Middle Name:
Last Name:MANN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 S LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-5594
Mailing Address - Country:US
Mailing Address - Phone:909-747-7946
Mailing Address - Fax:
Practice Address - Street 1:101 REDLANDS MALL
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4705
Practice Address - Country:US
Practice Address - Phone:909-747-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist