Provider Demographics
NPI:1205438561
Name:MANEELY, KATIE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MANEELY
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 1:2130 PALOMINO RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3669
Mailing Address - Country:US
Mailing Address - Phone:717-292-3043
Mailing Address - Fax:
Practice Address - Street 1:2130 PALOMINO RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:PA
Practice Address - Zip Code:17315-3669
Practice Address - Country:US
Practice Address - Phone:717-292-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445644183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist