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General NPI Number Information
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NPI Number | 1871884411
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Entity Type | Individual
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Provider Name | THOMAS TERRY MANLEY PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 05/01/2011
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Last Update Date | 05/01/2011
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Provider Practice Location Address
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Address Line | 2025 LEESTOWN RD STE B
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City | LEXINGTON
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State | KY
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Zip | 40511-1000
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Country | US
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Telephone | 859-233-0936
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 TINA CT
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City | MT STERLING
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State | KY
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Zip | 40353-8134
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Country | US
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Telephone | 859-498-6050
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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 | 007163
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License Number State | KY
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