MEDICARE: JAMES ROBERT MANFRED 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	26013834A	IN
2	183500000X	Pharmacist	0000019781	TN
3	183500000X	Pharmacist	03-1-26039	OH
4	183500000X	Pharmacist	013079	KY
5	183500000X	Pharmacist	17188	CO

General Provider Information

NPI Number	:	1336164854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ROBERT MANFRED RPH

Provider Business Mailing Address
First Line	:	424 HUNTINGTON RIDGE DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-5992
Country	:	US
Telephone Number	:	615-468-6571
Fax Number	:	615-468-1900

Provider Business Practice Location Address
First Line	:	205 MILLERSPRINGS CT
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5434
Country	:	US
Telephone Number	:	615-468-6571
Fax Number	:	615-468-1900

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	11/15/2011

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