Healthcare Provider Details

I. General information

NPI: 1063320356
Provider Name (Legal Business Name): MANAKO WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5544 OLD HICKORY BLVD
HERMITAGE TN
37076-2576
US

IV. Provider business mailing address

5544 OLD HICKORY BLVD
HERMITAGE TN
37076-2576
US

V. Phone/Fax

Practice location:
  • Phone: 615-883-0332
  • Fax: 615-883-8155
Mailing address:
  • Phone: 615-883-0332
  • Fax: 615-883-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number49978
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: