MEDICARE: MR. GREGORY KEITH MANLEY RPH

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	10377	AL
2	183500000X	Pharmacist	E-07032	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E-07032	OTHER	MS	MS PHARMACIST LICENSE
2	10377	OTHER	AL	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1184711152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY KEITH MANLEY RPH

Provider Business Mailing Address
First Line	:	2790 NEEDHAM RD
Second Line	:
City	:	NEEDHAM
State	:	AL
Zip	:	36915-3001
Country	:	US
Telephone Number	:	205-673-2820
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 E PUSHMATAHA ST
Second Line	:
City	:	BUTLER
State	:	AL
Zip	:	36904-2620
Country	:	US
Telephone Number	:	205-459-2990
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/08/2007

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