Provider Demographics
NPI:1669679312
Name:MCMANUS, PHILLIP E (D PH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:E
Last Name:MCMANUS
Suffix:
Gender:M
Credentials:D PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2501
Mailing Address - Country:US
Mailing Address - Phone:423-245-2181
Mailing Address - Fax:423-245-7261
Practice Address - Street 1:1425 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2501
Practice Address - Country:US
Practice Address - Phone:423-245-2181
Practice Address - Fax:423-245-7261
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2231OtherPHARMACIST