Provider Demographics
NPI:1255614780
Name:MANUEL, KIMBERLY BANNER (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BANNER
Last Name:MANUEL
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 1:254 BART GREEN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4609
Mailing Address - Country:US
Mailing Address - Phone:423-220-6016
Mailing Address - Fax:
Practice Address - Street 1:6740 BRISTOL HWY
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-5231
Practice Address - Country:US
Practice Address - Phone:423-391-1227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist