Provider Demographics
NPI:1790403947
Name:MANIS, TAYLOR NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:NICOLE
Last Name:MANIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 SUGAR LOAF RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-2421
Mailing Address - Country:US
Mailing Address - Phone:865-256-3811
Mailing Address - Fax:
Practice Address - Street 1:11305 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4811
Practice Address - Country:US
Practice Address - Phone:865-579-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist