Healthcare Provider Details

I. General information

NPI: 1699690024
Provider Name (Legal Business Name): KATHERINE MANLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

355 FARRINGTON BLVD
NORTH BRUNSWICK NJ
08902-3248
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax:
Mailing address:
  • Phone: 732-439-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI04509100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: