Provider Demographics
NPI:1194948620
Name:KAREN M RIDGWAY
Entity type:Organization
Organization Name:KAREN M RIDGWAY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIDGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:937-254-2664
Mailing Address - Street 1:3101 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-2139
Mailing Address - Country:US
Mailing Address - Phone:937-254-2664
Mailing Address - Fax:937-254-0783
Practice Address - Street 1:3101 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2139
Practice Address - Country:US
Practice Address - Phone:937-254-2664
Practice Address - Fax:937-254-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0744700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1206530001Medicare NSC