MEDICARE: CHARLES RUSSELL MANEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202009114	VA

General Provider Information

NPI Number	:	1275814584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES RUSSELL MANEY RPH

Provider Business Mailing Address
First Line	:	3813 GASKINS RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-1436
Country	:	US
Telephone Number	:	804-747-7787
Fax Number	:	804-747-8721

Provider Business Practice Location Address
First Line	:	3813 GASKINS RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-1436
Country	:	US
Telephone Number	:	804-747-7787
Fax Number	:	804-747-8721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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