Provider Demographics
NPI:1336462795
Name:MCMANUS, THOMAS LEE
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LEE
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 OLD FARM LN
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-2717
Mailing Address - Country:US
Mailing Address - Phone:518-622-3563
Mailing Address - Fax:
Practice Address - Street 1:75 OLD FARM LN
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413-2717
Practice Address - Country:US
Practice Address - Phone:518-622-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029593-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY029593-1OtherPHARMACIST LICENSE