Provider Demographics
NPI:1821271883
Name:MANNING, EDWARD W JR (RPH)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:W
Last Name:MANNING
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 1:1170 NE INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-1100
Mailing Address - Country:US
Mailing Address - Phone:601-482-7420
Mailing Address - Fax:601-482-7490
Practice Address - Street 1:1170 NE INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1100
Practice Address - Country:US
Practice Address - Phone:601-482-7420
Practice Address - Fax:601-482-7490
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE5493183500000X
AL10011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist