Provider Demographics
NPI:1134203524
Name:MCMANUS, BARBARA LACEY (DPH)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LACEY
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:MISS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2044
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?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC002181OtherPHARMACIST LICENSE