Provider Demographics
NPI:1023552502
Name:MANNON, NANCY HUMPHREY (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:HUMPHREY
Last Name:MANNON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:SPECIALTY PHARMACY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:859-218-5413
Mailing Address - Fax:859-323-5861
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:SPECIALTY PHARMACY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-218-5413
Practice Address - Fax:859-323-5861
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00093421835P2201X
WV00041451835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care