Provider Demographics
NPI:1689172009
Name:MANLEY, CHARLES (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:MANLEY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1536
Mailing Address - Country:US
Mailing Address - Phone:731-658-7181
Mailing Address - Fax:731-658-7324
Practice Address - Street 1:1604 W MARKET ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1536
Practice Address - Country:US
Practice Address - Phone:731-658-7181
Practice Address - Fax:731-658-7324
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist