Provider Demographics
NPI:1740566892
Name:MANUS, DONALD LEE JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LEE
Last Name:MANUS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 WESTWOOD LN STE A
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2638
Mailing Address - Country:US
Mailing Address - Phone:336-667-9347
Mailing Address - Fax:336-667-9350
Practice Address - Street 1:1300 WESTWOOD LN STE A
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2638
Practice Address - Country:US
Practice Address - Phone:336-667-9347
Practice Address - Fax:336-667-9350
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0855188Medicaid
NC2801295OtherMEDICARE PTAN