MEDICARE: DR. HAROLD J MANLEY PHARMD

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	042270	NY
2	183500000X	Pharmacist	045287	MO
3	1835P1200X	Pharmacotherapy Pharmacist	297218	DC

General Provider Information

NPI Number	:	1568468957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD J MANLEY PHARMD

Provider Business Mailing Address
First Line	:	25 PARKWYN DR
Second Line	:
City	:	DELMAR
State	:	NY
Zip	:	12054-4107
Country	:	US
Telephone Number	:	518-439-5285
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 PARKWYN DR
Second Line	:
City	:	DELMAR
State	:	NY
Zip	:	12054-4107
Country	:	US
Telephone Number	:	518-439-5285
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/25/2008

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