Provider Demographics
NPI:1467809681
Name:MANNING, KRISTYN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KRISTYN
Middle Name:
Last Name:MANNING
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 1:475 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-2944
Mailing Address - Country:US
Mailing Address - Phone:815-462-1998
Mailing Address - Fax:815-462-1896
Practice Address - Street 1:475 NELSON RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2944
Practice Address - Country:US
Practice Address - Phone:815-462-1998
Practice Address - Fax:815-462-1896
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-039838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist