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General NPI Number Information
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NPI Number | 1790403947
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Entity Type | Individual
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Provider Name | TAYLOR NICOLE MANIS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/15/2022
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Provider Practice Location Address
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Address Line | 11305 CHAPMAN HWY
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City | SEYMOUR
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State | TN
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Zip | 37865-4811
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Country | US
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Telephone | 865-579-3141
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Fax |
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Provider Business Mailing Address
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Address Line | 919 SUGAR LOAF RD
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City | SEVIERVILLE
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State | TN
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Zip | 37876-2421
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Country | US
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Telephone | 865-256-3811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 46311
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License Number State | TN
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