Provider Demographics
NPI:1194062398
Name:SEVERANCE, MARY ELIZABETH GUY (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH GUY
Last Name:SEVERANCE
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 1:7520 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7611
Mailing Address - Country:US
Mailing Address - Phone:352-316-5585
Mailing Address - Fax:352-331-1098
Practice Address - Street 1:7520 W UNIVERSITY AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7611
Practice Address - Country:US
Practice Address - Phone:352-316-5595
Practice Address - Fax:352-331-1098
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist