Provider Demographics
NPI:1700120722
Name:MANNING, TINA BLAZER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:BLAZER
Last Name:MANNING
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 1:453 RED FOX TRL
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2674
Mailing Address - Country:US
Mailing Address - Phone:252-402-6992
Mailing Address - Fax:
Practice Address - Street 1:3069 RICHLANDS HWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-2976
Practice Address - Country:US
Practice Address - Phone:910-219-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist