Provider Demographics
NPI:1649870049
Name:MCMANUS, LINDA MARIE (RPH)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15470 HIGHWAY JJ
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-6686
Mailing Address - Country:US
Mailing Address - Phone:573-253-9026
Mailing Address - Fax:
Practice Address - Street 1:4820 S CLARK ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-4111
Practice Address - Country:US
Practice Address - Phone:573-581-2600
Practice Address - Fax:573-582-7104
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist