Provider Demographics
NPI:1871884411
Name:MANLEY, THOMAS TERRY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:TERRY
Last Name:MANLEY
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 TINA CT
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8134
Mailing Address - Country:US
Mailing Address - Phone:859-498-6050
Mailing Address - Fax:
Practice Address - Street 1:2025 LEESTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-1000
Practice Address - Country:US
Practice Address - Phone:859-233-0936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist