Provider Demographics
NPI:1528429313
Name:MANLEY, BRENDA KAYE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAYE
Last Name:MANLEY
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 1:104 S FREYA ST STE 225
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-4887
Mailing Address - Country:US
Mailing Address - Phone:509-536-1900
Mailing Address - Fax:509-536-1999
Practice Address - Street 1:104 S FREYA ST STE 225
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4887
Practice Address - Country:US
Practice Address - Phone:509-536-1900
Practice Address - Fax:509-536-1999
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHA00018310183500000X
MTPHA-PHA-LIC-16775183500000X
AK2187183500000X
IDP6795183500000X
ORRPH-0015157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist