MEDICARE: MR. NEAL JEFFREY MANLEY 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	11299	NV

General Provider Information

NPI Number	:	1417250440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NEAL JEFFREY MANLEY RPH

Provider Business Mailing Address
First Line	:	7530 WLAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0237
Country	:	US
Telephone Number	:	702-228-4742
Fax Number	:	702-228-3068

Provider Business Practice Location Address
First Line	:	7530 WLAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0237
Country	:	US
Telephone Number	:	702-228-4742
Fax Number	:	702-228-3068

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

Provider Enumeration Date	:	12/14/2010
Last Update Date	:	12/14/2010

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