Provider Demographics
NPI:1336164854
Name:MANFRED, JAMES ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:MANFRED
Suffix:
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 1:424 HUNTINGTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5992
Mailing Address - Country:US
Mailing Address - Phone:615-468-6571
Mailing Address - Fax:615-468-1900
Practice Address - Street 1:205 MILLERSPRINGS CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5434
Practice Address - Country:US
Practice Address - Phone:615-468-6571
Practice Address - Fax:615-468-1900
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013834A183500000X
TN0000019781183500000X
OH03-1-26039183500000X
KY013079183500000X
CO17188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist